[INDICATIONS FOR ANTITHROMBOTIC MEDICATION DURING PREGNANCY--ANALYSIS OF CURRENT PRACTICES IN BULGARIA].

AIM: To analyze current practices in Bulgaria regarding antithrombotic medication (AM) during pregnancy, and to compare them with the ones recommended in literature.

MATERIALS AND METHODS: In 84 pregnant women who were low dose aspirin (LDA) or/and low molecular weight heparin (LMWH) or unfractionated heparin (UH), data about AM were collected and analyzed. A descriptive analysis was performed of the indications for AM, its type, the applied doses and therapeutic regimens.

RESULTS: 39/84 pregnant women (46.4%) had indications for AM. In 18/84 cases (21.4%) the type of AM was precisely selected according to the indications. Of them 12 were on LDA alone (8--history of early preeclampsia/IUGR, 2--diabetes, 1--autoimmune disease, 1--chronic hypertension), 4--on LMWH/UF alone (2--venous thromboembolism, 2--essential thrombocytemia) and 2 received both LMH and LDA (1--antiphospholipid syndrome, 1--phlebothrombosis and stillbirth). Another 21/84 cases (25%) had indications for AM but its type was not appropriately selected. This subgroup included cases with high risk inherited thrombophylia (IT), history of placental mediated disease (PMD) in previous pregnancies and/or accompanying medical disorders. These patients had indications for either LDA or LMA administration, but were on combined medication. In 45/84 cases (53.6%) with uneventful past obstetric history or early pregnancy losses (before 10 w.g.) but no PMD there were no indications for AM. Among them, 17/84 (20.2%) had low risk IT in 18/84 (21.4%) IT was ruled out and 10/84 (12%) were not tested for IT at all. In total, 64/84 patients (76.2%) were on LDA--alone (25/84 - 29.8%), or in combination with LMWH (39/84 - 46.4%). Treatment with LDA was indicated in 45/64 (70.3%) cases--12/25 (48%) of the ones who were on LDA alone and 23/39 (59%) of those on LDA and LMW In 19/64 cases (29.7%) LDA administration was not indicated. 59/84 (70.2%) of the patients were on LMW/UH- alone (20/84 - 23.8%) orin combination with LDA (39/84 - 46.4%). This therapy was indicated in only 6/59 cases (10.2%), treated with LMWH/UH - 4/20 (20%) of the ones on LMWH/UH alone and 2/39 (5.2%) of the ones on LDA plus LMWH. In 53/59 cases (89.8%) the administration of LMWH was not indicated. LDA was started preconceptionally, in the Ist or in the lind trimester in 12/64 (18.7%), 32/64 (50%) and 6/64 (9.4%) of the cases respectively. LMWN/UH was started preconceptionally, in the Ist orin the lind trimester in 5/59 (8.6%), 33/59 (56.9%) and 5/59 (8.6%) of the cases respectively. The information when AM was started was not reliable in 14/64 (21.9%) cases on LDA and in 16/59 (27.1%) - on LMWH. In 12/84 cases (14.3%) LDA and LMWH were administered every other day. This referred to 5/64 (7.8%) cases on LDA and to 7/58 (12.1%) - on LMWH. LDA and LMWH were administered in PAI 4G/4G polymorphism despite the fact that in'these cases fibrinolysis but not coagulation was affected.

CONCLUSIONS: AM was administered according to strict indications and with appropriately selected preparations in only 21.4% of the studied cases. In another 25% there were indications for AM, but its type was not precisely selected. 53.6% of the patients had no indications for AM. LDA administration (alone or in combination with LMWH) was indicated in 70.9% of the cases; the same referred to only 10.2% of the ones who were on LMWH. Application/administration of AM every other day was inappropriate given the pharmacokinetics of the preparations. AM was also applied in IT with decreased fibrinolysis but not increased coagulability.