Haematologica 2004;89: supplement no. 8 - Supplements ...

128Postersexcess of the anticoagulation effect. No heparinrelatedfetal complications occurred. Conclusions.Pregnancy-related VTE occur evenly throughout gestationand peak in post-partum period, mostly inpatient delivered by caesarean section. Inherited oracquired thrombophilia is detected in about one thirdof the cases. LMWH is the treatment of choice inpregnant women. Careful evaluation is needed inpost-partum period.PO-067RISK OF VENOUS THROMBOEMBOLISM AMONG WOMENWITH A PREVIOUS HISTORY OF OBSTETRIC COMPLICATIONSDe Stefano V, Rossi E, Ferrazzani S,* De Carolis S,*Za T, D'Orazio A, Caruso A,* Leone GInstitute of Hematology and *Department ofObstetrics and Gynecology, Catholic University,Rome, ItalyInherited thrombophilia and antiphospholipid antibodies(aPL) are established risk factors for venousthromboembolism (VTE); they are recognized also asrisk factors for obstetric complications (preeclampsia,recurrent miscarriage, intrauterine fetal death).Occlusive changes of placental vessels leading tounderperfusion are hypothesized as the link betweenthrombophilia and obstetric complications. Yet therisk for VTE or obstetric complications seems to beshared by the same individuals only in a part of thecarriers of thrombophilia. In order to investigate therisk for VTE among women with obstetric complicationswe investigated 225 women with a history of2 or more uneplained fetal losses before the 20thweek of gestation (group A), 88 women with a historyof at least 1 fetal death after the 20th week ofgestation (in 45 cases associated also with at least1 miscarriage) (group B), and 180 women with a historyof preeclampsia (group C). A history of VTE waspresent in 26 women of the group A (11.5%), 16women of the group B (18.1%), and 16 women of thegroup C (8.9%). Thrombophilia, defined as the presenceof AT, PC, PS deficiency, factor V Leiden, PT20210A, and aPL as a single trait or in combination,was detected in 41.3% of the group A, 51.1% of thegroup B, and 26.6% of the group C. The carriershipof thrombophilia did not produce any increase in therisk of VTE among the women with recurrent miscarriage(relative risk 1.1, 95% CI 0.7-1.7) and thewomen with fetal death (RR 1.3, 95% CI 0.8-2.0) aswell as in the whole cohort of women with fetal losses(RR 1.2, 95% CI 0.9-1.6); this was the case alsofor the women with a history of preeclampsia (RR0.9, 95% 0.4-2.2). Such results did not substantiallychange after adjustement for the presence of aPLneither considering as outcome of interest only VTEoccurred during pregnancy and puerperium (14 casesin the groups A + B, 7 cases in the group C). Overall,174 pregnancies (of 1002) were completed bythe women of the groups A + B, and 314 pregnancies(of 425) were completed by the women of thegroup C. The VTE rate was estimated 4.6% antepartumand 3.4% postpartum among the women withfetal losses; the VTE rate among women withpreeclampsia was 0.6% antepartum and 1.6% postpartum.Therefore it can be suggested a higher riskof VTE during subsequent pregnancies amongwomen with a history of obstetric complications;underestimation of such risk could depend on thelow rate of pregnancy completion.PO-068D-DIMER AS FIRST MARKER OF THROMBOPHILIA IN WOMENAFFECTED BY UNEXPLAINED PRIMARY OR SECONDARYINFERTILIYDi Micco P,* D'Uva M,° Strina I,° Granata G,*Bonamassa B,* Mollo A,° Amato V,° de Marino C,°Niglio A,* De Placido G°*IV Divisione di Medicina Interna e PatologieEpato-bilio-metaboliche Avanzate, SecondaUniversità di Napoli, Napoli; °DipartimentoUniversitario di Scienze Ostetriche Ginecologiche eMedicina della Riproduzione, Area Funzionale diMedicina della Riproduzione ed Endoscopia Ginecologica,Universita degli Studi di Napoli 'Federico II',Napoli, ItalyBackground. D-dimer is considered a marker ofhypercoagulable state besides of endogenous fibrinolysis,so increased d-dimer is detectable in patientsaffected by thrombosis. Yet, several studies showedthat also infertility, in particular secondary infertilitydue to recurrent fetal losses, have been oftenrelated to thrombotic events, in particular in womencarrying thrombotic risk factors such as inheritedthrombophilia (MTHFRC677T, PTHRA20210G, FactorV Leiden polimorphisms and/or inherited protein C,protein S, AT III deficiency) or acquired thrombophilia(primary antiphospholipid syndrome, acquired proteinC, protein S, AT III deficiency, drugs inducedthrombophilia). However, because its high predictivenegative value in case of suspected thrombosis,increased d-dimer have been often associated tosubclinical thrombophilia. The aim of this study is toinvestigate the role of d-dimer as first marker ofthrombophilia in women affected by unexplainedinfertility and subsequently to search the cause ofincreased d-dimer, such as inherited and/or acquiredthrombophilia. Patients and Methods. We selected55 patients with unexplained primary or secondaryinfertility. We excluded patients affected by hydros-haematologica vol. 89(suppl. n. 8):september 2004