LISBON — There is absolutely no reason today to universally screen pregnant women for inherited thrombophilias, Dr. Ian A. Greer said at the 15th World Congress of the International Society for the Study of Hypertension in Pregnancy.
Although easy and accurate tests for inherited thrombophilias are available, the best management of women who have these disorders remains unclear. A systematic review of the literature turned up results from just one randomized, controlled trial showing that pregnant women with a thrombophilia—in this case, antiphospholipid syndrome—had a modest benefit from treatment with aspirin and heparin, said Dr. Greer, professor of obstetrics and gynecology at the University of Glasgow, Scotland. But antiphospholipid syndrome is an acquired, not inherited, thrombophilia and no other results from randomized, controlled trials in women with a thrombophilia have been reported, he said.
The top priority today is to run more controlled studies to test various antithrombotic treatments in women with thrombophilia rather than starting widespread screening, Dr. Greer said. Although aspirin, unfractionated heparin, and low-molecular-weight heparin are all treatment options, alone or in combination, not enough evidence currently exists to recommend any specific regimen over the others.
Dr. Greer and his associates have run a cost-effectiveness analysis of thrombophilia screening and treatment, using a hypothetical, representative population of 10,000 pregnant women. They assumed that treatment with low-molecular-weight heparin would have an 80% efficacy for preventing adverse maternal and fetal outcomes, including intrauterine growth restriction, miscarriage, and preeclampsia.
In this analysis, the cost for preventing a single adverse event through universal screening would be about $90,000. The cost to prevent a single adverse event would be about $80,000 using selective screening of women with a personal or family history of thrombophilia or venous thromboembolism, Dr. Greer said.