Anticoagulant Therapy in Pregnant Patients with Metabolic Syndrome: A Review
Radzisław Mierzynski, Elzbieta Poniedzialek-Czajkowska, Zaneta Kimber-Trojnar, Bozena Leszczynska-Gorzelak and Jan Oleszczuk
Affiliation: Department of Obstetrics and Perinatology, Medical University of Lublin, Ul. Jaczewskiego 8, 20-954 Lublin, Poland.
Keywords: Aspirin, fondaparinux, heparin, low molecular weight heparin, metabolic syndrome, pregnancy, warfarin.
Pregnancy is a specific state of heightened coagulability related to the increase in procoagulant agents and to
the reduced fibrinolysis. Pregnancy is associated with a 4-fold increased risk of developing venous thromboembolism
(VTE) and this risk still increases to 14-fold during puerperium. A correlation between the metabolic syndrome and development
of cardiovascular events and cerebrovascular incidents has been described. Such a relationship is referred to a
hypercoagulable state due to increased serum levels of the plasminogen activator inhibitor-1 (PAI-1), fibrinogen, factor
(F) VII and VIII, von Willebrand factor and from endothelial activation, caused by increased circulating adhesion molecules.
As to the risk of VTE, the probability for its association with cardiovascular incidents is increased by common underlying
mechanisms such as the activation of platelets and the blood coagulation. A correlation between idiopathic VTE
and the metabolic syndrome has been reported. The anticoagulant therapy may be recommended during the pregnancy for
the treatment or the prophylaxis of VTE and, in women with artificial heart valves, for the prevention of the valve thrombosis
and systemic embolisation. There are also specific conditions during pregnancy which benefit from anticoagulant
use, such as recurrent fetal loss, thrombophilia and assisted reproductive technology. There are no published specific data
about using of anticoagulant agents in pregnant patients with the metabolic syndrome except for a few articles addressing
reproductive problems. The mechanisms of anticoagulant action were studied with the focus on heparinoids, because of
their safety not only for the patient but also for the fetus. The new oral anticoagulants were also shortly described although
they have been contraindicated during the pregnancy.
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