Thrombophilia and Recurrent Pregnancy Loss : Is Heparin Still the Drug of Choice ? = أهبة التخثر و فقدان الحمل المتكرر : هل الهيبارين لايزال العلاج المفضل ؟

Adel Abu-Heija

doi:10.12816/0003333

Abstract

The association between thrombophilia and recurrent pregnancy loss (RPL) has become an undisputed fact. Thorombophilia creates a hypercoaguable state which leads to arterial and/or venous thrombosis at the site of implantation or in the placental blood vessels. Anticoagulants are an effective treatment against RPL in women with acquired thrombophilia due to antiphospholipid syndrome. The results of the use of anticoagulants for treating RPL in women with inherited thrombophilia (IT) are encouraging, but recently four major multicentre studies have shown that fetal outcomes (determined by live birth rates) may not be as favourable as previously suggested. Although the reported side-effects for anticoagulants are rare and usually reversible, the current recommendation is not to use anticoagulants in women with RPL and IT, or for those with unexplained losses. This review examines the strength of the association between thrombophilia and RPL and whether the use of anticoagulants can improve fetal outcomes.

Highlights

The association between thrombophilia and recurrent pregnancy loss (RPL) has become an undisputed fact
The results showed a significant increase in prematurity with low-dose aspirin (LDA) alone in comparison to a combination of heparin with LDA, and both of these treatment options were compared to a placebo
This was associated with a higher frequency of pregnancy loss and premature deliveries when compared to unfractionated heparin or low-molecular-weight heparin (LMWH) combined with LDA (RR = 2.51; 95% CI: 1.27–4.95)

Summary

Placebo

The authors found that the pregnancy loss rate was 22% in women receiving both LMWH and LDA, while the pregnancy loss rate was 20% in the group who were only intensively monitored They concluded that their results do not support the use of LMWH and/or LDA in women with RPL not due to APS. This study showed that neither a combination of LMWH and LDA nor LDA alone improved the live birth rate when compared with the use of a placebo in women with RPL. The Heparin and Aspirin (HepASA) trial studied 88 pregnant women with RPL who were either aPLpositive, or who had IT or antinuclear antibodies.[62] Women were randomised into two groups, with group one (n = 45) receiving LMWH plus LDA while group two (n = 43) received LDA alone.

Findings

Conclusion