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IVF, pregnancy complications and thrombophilia
1. Causality
• Strength and consistency of association
• Specificity
• Biologic plausibility and gradient
• Analogy
• Experimentation
2.
Therapeutic implications
• Do anticoagulants improve outcome?
• If so, specifically in women with thrombophilia?
How strong is the association?
Recurrent early miscarriage
Late Fetal Loss
Preeclampsia
Lupus anticoagulant
3.0 (1.0 – 8.6)
10.6 (1.9-59.9)
1.5 (0.76-2.8)
Anticardiolipin antibodies
5.1 (1.8-14.0)
8.9 (1.84-42.5)
2.7 (1.7-4.5)
Antibeta2 glycoprotein I antibodies
2.1 (0.69 – 6.53)
23.5 (1.2-455)
19.1 (6.3-57.8)
Factor V Leiden
2.0 (1.5-2.7)
3.3 (1.8-5.8)
1.2 (0.89-1.7)
Prothrombin 20210A
2.0 (1.0-4.0)
2.3 (1.1-4.9)
1.3 (0.79-2.0)
Protein C deficiency
1.6 (0.23-10.5)
1.4 (0.96-2.1)
5.5 (0.3-102)
Protein S deficiency
14.7 (0.99-218.0)
7.4 (1.3-42.8)
2.8 (0.8-10.6)
Antithrombin deficiency*
-
-
3.9 (0.2-97)
Robertson Br J Haematol 2006; Abou-Nassar Thromb Res 2011; Rodger J Thromb Haemost 2014
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