Если вкратце:
1/ При беременности Д-Димер и Фибриноген повышаются, это естественная и нормальная реакция организма, которая также может быть следствием приема гормонов перед этим, поэтому только основываясь на этом НЕ НУЖНО принимать гепарины.
2/ У всех есть мутации, по ним диагнозы не ставят. О низком риске развития тромбофилии свидетельствует наличие таких полиморфизмов как гетерозигота F5 (мутация Лейдена) и F2 - протромбин (фактор II свертывания крови) 20210 G>A, дефицит Протеина S и дефицит Протеина С. Высокий фактор риска развития тромбофилии при наличии гомозигот F5 и F2. Для установления диагноза учитывается наличие у родственников первой линии случаев тромбозов в возрасте до 50 лет.
3/ Данных, подтверждающих то, что гепарины и аспирин (чаще всего назначают при тромбофилии) улучшают исход беременности НЕ существует.
ASRM 2012: P. 5."Screening for inherited thrombophilias (specifically, factor V
Leiden and the prothrombin genemutations, protein C, protein
S, and antithrombin deficiencies) may be clinically justified
when a patient has a personal history of venous thromboembolism
in the setting of a non-recurrent risk factor (such as
surgery) or a first-degree relative with a known or suspected
high-risk thrombophilia. Although an association between
hereditary thrombophilias and fetal loss has been suggested
(51, 52), prospective cohort studies have failed to confirm
this (53, 54). Routine testing of women with RPLfor inherited
thrombophilias is not currently recommended (24, 55)".
Про Клексан и прочие Низкомолекулярные гепарины
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ГЕПАРИНЫ
Efficacy of low‐molecular‐weight heparin on the outcomes of in vitro fertilization/intracytoplasmic sperm injection pregnancy in non‐thrombophilic women: a meta‐analysis
Introduction
The aim of our study was to evaluate the effect of low‐molecular‐weight heparin on pregnancy outcomes in women without thrombophilia during in vitro fertilization/intracytoplasmic sperm injection treatment.
Material and methods
We searched Pubmed, Web of Science, Embase, Cochrane and CNKI (from inception to 2 February 2018). Our study identified randomized controlled trials or quasi‐randomized controlled trials comparing low‐molecular‐weight heparin subcutaneous treatment with no treatment or only luteal support control. The outcomes included live birth rate, clinical pregnancy rate and miscarriage rate.
Results
Five trials, including 935 women receiving in vitro fertilization/intracytoplasmic sperm injection treatment, were included in meta‐analyses. There were 458 women receiving low‐molecular‐weight heparin and 477 in the control group. No significant differences for live birth rate, clinical pregnancy rate and miscarriage rate were found between the low‐molecular‐weight heparin and control groups. Of them, four trials reported live birth rate as an outcome and the risk ratio was 1.13 (95% confidence interval 0.88-1.43, p = 0.34). All five trials reported clinical pregnancy rate as an outcome, the risk ratio was 1.08 (95% confidence interval 0.87-1.32, p = 0.47). Three trials reported miscarriage rate and the risk ratio was 0.58 (95% confidence interval 0.30-1.10, p = 0.09). In women with two or more failed in vitro fertilization/intracytoplasmic sperm injection cycles, the risk ratio of live birth rate was 1.15 and the risk ratio of clinical pregnancy rate was 1.17. In women with three or more failed in vitro fertilization/intracytoplasmic sperm injection cycles, the risk ratios of live birth rate and clinical pregnancy rate were 1.36 and 1.35, respectively.
Conclusions
Our results suggested that low‐molecular‐weight heparin had no effect on pregnancy success rate in non‐thrombophilic women undergoing in vitro fertilization/intracytoplasmic sperm injection treatment. However, to justify the use of low‐molecular‐weight heparin in clinical practice, multicenter trials are still necessary.