Heparin Use in Pregnant Women Diagnosed With Thrombophilia: Obstetric Outcomes

Julio Rezende De Andrade,Ricardo Augusto Barcelos Maciel,Larissa Milani Coutinho,Juliana Barroso Zimmermmann,Sophia Batalha,Marina Valadao Camargos,Alexander Cangussu Silva,Hakayna Calegaro Salgado,Clarissa Rocha Panconi,Mariana Pinto Sirimarco,Tamara Teixeira Mello,Joao Matheus De Castro Rangel,Veronica Marques Matos,Mateus Figueiredo De Rezende Reis

doi:10.35248/2090-7214.19.16.331

Abstract

Introduction: Thrombophilias are associated with venous thromboembolism. According to reports, uteroplacental thrombosis can lead to preeclampsia, intrauterine growth restriction (IUGR), placental abruption (PA) and even to fetal death. The Brazilian Ministry of Health recommends the application of heparin treatment-associated, or not, with ASA to pregnant women diagnosed with thrombophilia, based on its type. However, many studies have not been able to confirm the beneficial effects of heparin use on maternal and fetal health. Methods: The current research is a case-control study comprising pregnant women treated at the Obstetrics Service of Federal University of Juiz de Fora and at the Medical School of Barbacena, who used heparin in the current pregnancy due to previously diagnosed thrombophilia. Current pregnancy associated with heparin use was named ‘case’, whereas previous pregnancy without heparin use was named ‘control’. Thus, 47 cases (current pregnancy) and 32 controls were selected (1,4 cases: 1,0 control). Results: Association between heparin and miscarriage, intrauterine fetal death and preeclampsia were analyzed. Results showed that heparin acted as protective factor against miscarriage (OR=0.04; CI=0.01-0.14; p<0.0001), intrauterine fetal death (OR=0.01; CI=0.01-0.11; but heparin use did not reduce the frequency of preeclampsia cases (OR=0.35; CI=0.07-1.6; p=0.17). Conclusion: Based on the current results, the early heparin application to pregnant women with thrombophilia was able to reduce the number of miscarriage, intrauterine death, but did not reduce the frequency of preeclampsia.

Highlights

Uteroplacental thrombosis can lead to preeclampsia, intrauterine growth restriction (IUGR), placental abruption (PA) and even to fetal death [1,2,3,4]
Heparin can be administered to pregnant women to treat venous thromboembolism, in thromboprophylaxis, as well as to prevent adverse obstetric effects such as preeclampsia, intrauterine growth restriction (IUGR), stillbirths and recurrent pregnancy loss
In light of the foregoing, the aim of the current study was to evaluate the frequency of unfavorable obstetric outcomes such as miscarriage, fetal death, intrauterine growth restriction and preeclampsia in pregnant women treated with heparin, by using their previous heparin-free pregnancy as control

Summary

Introduction

Conclusion: Based on the current results, the early heparin application to pregnant women with thrombophilia was able to reduce the number of miscarriage, intrauterine death, but did not reduce the frequency of preeclampsia. Unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) do not cross the placental barrier; they are the most prescribed anticoagulant drugs during pregnancy, their prolonged use is not risk-free, since they are associated with thrombocytopenia, hemorrhage and osteoporosis. Aspects such as discomfort caused by the application of these drugs, difficulty to control anticoagulation and costs with such treatments cannot be ignored.

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Results

Discussion

Conclusion