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Women and coagulation disorders
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When: 9/24/2014

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ISTH Webinar:

Women and coagulation disorders, September 24, 2014

5:00-6:00 PM GMT


Sarah O’Brien (women and anticoagulation)

Saskia Middeldorp (thrombophilia and pregnancy)

Learning objective:

How to manage menorrhagia, pregnancy and delivery and related complications in patients with coagulation disorders

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Managing Heavy Menses and Pregnancy in Patients with Inherited Bleeding Disorders – Sarah O’Brien, MD, Nationwide Children’s Hospital, Columbus Ohio

This presentation will first review the frequency and patterns of heavy menstrual bleeding in women with inherited bleeding disorders, as well as the available literature regarding management strategies in this patient population. The increased risk of other reproductive bleeding (ovarian cysts and endometriosis) in women with bleeding disorders will also be recognized. We will then review the epidemiology of post-partum bleeding in this patient population, as well as recommended preventive and treatment strategies to reduce post-partum hemorrhage.

Thrombophilia and Pregnancy—Saskia Middeldorp, MD, Academic Medical Center, Amsterdam, The Netherlands
This presentation will review the epidemiology of thrombophilia and pregnancy-related VTE. The current recommendations for thrombosis prophylaxis (in whom, with what agent, and at what dose) and therapy of acute VTE will be reviewed. Also, practical issues regarding the management of delivery and neuraxial anesthesia in women using anticoagulant therapy while pregnant will be discussed. Furthermore, the association of thrombophilia with pregnancy complications such as preeclampsia and recurrent miscarriage will be summarized, as well as current evidence on treatment with aspirin and / or heparin.

At the conclusion of this presentation, participants should be able to

1. Recognize clinical symptoms suggestive of an underlying inherited bleeding disorder in women presenting with a complaint of heavy menstrual bleeding
2. Explain the various management options available to women with bleeding disorders and heavy menses
3. Employ recommended prevention and management strategies in pregnant women with bleeding disorders in order to reduce the risk of post-partum bleeding
4. Describe the impact of thrombophilia on risk of pregnancy-related venous thrombosis
5. Know the current recommendations regarding which women should receive thromboprophylaxis during pregnancy and puerperium, or during puerperium only
6. Describe the association between thrombophilia and pregnancy complications both quantitatively and qualitatively
7. Describe the state of the evidence with respect to prevention of pregnancy complications with aspirin and/or heparin in various subgroups of women, particularly women with APS and with inherited thrombophilia.

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