scholarly journals http://www.jirb.dormaj.com/issues/Volume%205,%20Issue%204/Anti-Coagulant%20Therapy%20in%20Unexplained%20Recurrent%20Pregnancy%20Loss.pdf

2017 ◽  
Vol 5 (4) ◽  
pp. 15-19
Keyword(s):  
Molecular Weight ◽  
Live Birth ◽  
Low Molecular Weight Heparin ◽  
Pregnancy Loss ◽  
Recurrent Pregnancy Loss ◽  
Recurrent Miscarriage ◽  
Controlled Study ◽  
Low Molecular Weight ◽  
Antiphospholipid Antibody ◽  
History Of

Recurrent pregnancy loss (RPL) is a heterogeneous reproductive problem with multiple aetiologies and contributing factors. It becomes quite challenging to form a work-up to detect the cause of RPL in the early months as a continuation of pregnancy involves many factors. In more than half of all recurrent miscarriage the cause still remains uncertain. Thrombophilia has been identified in about 50% of women with recurrent miscarriage and thromboprophylaxis has been suggested as an option of treatment.. In obstetric APLA Syndrome (Antiphospholipid antibody) the combination of aspirin and heparin has improved outcomes. The use of low molecular weight heparin (LMWH) has become a common practise in women with inherited thrombophilia and also those with unexplained miscarriage to help safeguard the ongoing pregnancy. To evaluate if there is any effectiveness of low molecular weight heparin (enoxaparin) in women with a history of at least two miscarriages without any apparent aetiology for recurrent pregnancy loss. A prospective randomised controlled study held at Vivekananda Institute of Medical Sciences, Kolkata from August 2015- July 2018. The study assessed the effect of anticoagulant treatment on the live-birth rate (primary outcome) in 80 antenatal women with a history of at least two miscarriages without any apparent causes. Interventions included low molecular weight heparin administration in one group and the other one was not given any anti-coagulant therapy. Similar live birth rates were observed with enoxaparin and the patients who did not receive any anti-coagulant, respectively 84% and 82% (RR 0.97, 95% CI 0.81 to 1.16). There were no significant differences in live birth weight and other pregnancy outcomes between the two groups. Therefore, there is no evidence to support any incremental benefit of adding LMWH to the treatment as a routine in unexplained cases of recurrent pregnancy loss.

Low Molecular Weight Heparin and Aspirin for Recurrent Pregnancy Loss: Results from the Randomized, Controlled HepASA Trial

2009 ◽  
Vol 36 (2) ◽  
pp. 279-287 ◽  
Author(s):  
CARL A. LASKIN ◽  
KAREN A. SPITZER ◽  
CHRISTINE A. CLARK ◽  
MARK R. CROWTHER ◽  
JEFF S. GINSBERG ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Femoral Neck ◽  
Live Birth ◽  
Low Molecular Weight Heparin ◽  
Pregnancy Loss ◽  
Recurrent Pregnancy Loss ◽  
Low Molecular Weight ◽  
Inclusion Criteria ◽  
Live Birth Rates ◽  
History Of

Objective.To compare live birth rates in women with recurrent pregnancy loss (RPL) and either autoantibodies or a coagulation abnormality, treated with low molecular weight heparin plus aspirin (LMWH/ASA) or ASA alone, and to place our results in context with other randomized clinical trials (RCT) with similar cohorts.Methods.The HepASA Trial was an RCT including patients with a history of RPL and at least 1 of the following: antiphospholipid antibody (aPL), an inherited thrombophilia, or antinuclear antibody. Treatment groups were stratified by aPL status and history of early versus late pregnancy losses. Patients received either LMWH/ASA or ASA alone. The primary outcome was live birth; secondary outcomes included adverse events and bone loss at the spine and femoral neck. Literature over the past 20 years was reviewed to identify comparable RCT.Results.Over 4 years, 859 women with RPL were screened: 88 (10.2%) fulfilled inclusion criteria, became pregnant and were randomized to receive either LMWH/ASA or ASA alone. aPL were present in 42 (47.7%) patients in each group. The trial was stopped after 4 years when an interim analysis showed no difference in live birth rates in the 2 groups, and a lower rate of pregnancy loss in the ASA only group than expected. In the LMWH/ASA group, 35/45 (77.8%) had a live birth versus 34/43 (79.1%) in the ASA only group (p = 0.71). Neither number of prior losses nor aPL status was correlated with pregnancy outcome. There were no cases of pregnancy related thrombosis in either group. Mean change in BMD did not differ by treatment group at either the lumbar spine (p = 0.57) or femoral neck (p = 0.15). RCT since 2000 for aPL positive women with RPL and similar inclusion criteria report a mean live birth rate of 75% with either LMWH or ASA.Conclusion.LMWH/ASA did not confer incremental benefit compared to ASA alone for this population. Regardless of treatment regimen, number of prior losses, or aPL positivity, almost 80% of women in our RPL cohort had a successful pregnancy outcome. These findings contribute to a growing body of literature that contests the emerging standard of care comprising LMWH/ASA for this population.

Gestational Outcome in Thrombophilic Women with Recurrent Pregnancy Loss Treated by Enoxaparin

2000 ◽  
Vol 83 (05) ◽  
pp. 693-697 ◽  
Author(s):  
R. Hoffman ◽  
Z. Blumenfeld ◽  
Z. Weiner ◽  
J. S. Younis ◽  
B. Brenner
Keyword(s):  
Molecular Weight ◽  
Live Birth ◽  
Antithrombotic Therapy ◽  
Low Molecular Weight Heparin ◽  
Pregnancy Loss ◽  
Recurrent Pregnancy Loss ◽  
Living Child ◽  
Low Molecular Weight ◽  
Single Living ◽  
Acquired Thrombophilia

SummaryInherited and acquired thrombophilia are associated with recurrent pregnancy loss (RPL). We have evaluated the efficacy and safety of the low molecular weight heparin enoxaparin in 50 women, (mean age 26 ± 3 years) with RPL (>3 losses in 1st, >2 losses in 2nd and >1 loss in 3rd trimester) who were found to harbor thrombophilia. Twentyseven had a solitary thrombophilic defect, and twenty-three women had combined thrombophilic defects: 17 – two defects and 6 – three defects. Following diagnosis of thrombophilia, sixty-one subsequent pregnancies were treated with the low molecular weight heparin enoxaparin throughout gestation until 4 weeks after delivery. Dosage was 40 mg/day in women with solitary defect and 80 mg/day in combined defects. Aspirin, 75 mg daily was given in addition to enoxaparin to women with antiphospholipid syndrome. Forty-six out of 61 (75%) gestations treated by enoxaparin resulted in live birth compared to only 38/193 (20%) of the untreated pregnancies in these 50 women prior to diagnosis of thrombophilia (p <0.00001). In 23 women without a single living child following 82 untreated gestations, antithrombotic therapy resulted in 26/31 (84%) successful deliveries (p <0.0001). In 20 women with a prior living child, antithrombotic therapy improved successful delivery from 33/86 (38%) to 20/21 (95%) (p <0.0001). Enoxaparin dose of 40 mg/day resulted in live birth in 24/35 (69%) of gestations, compared to 19/23 (83%) gestations in women treated with 80 mg/day (p = 0.37). Only one thrombotic episode and one mildbleeding episode were noticed during enoxaparin therapy. Enoxaparin is safe and effective in prevention of pregnancy loss in women with inherited and acquired thrombophilia.

Low Molecular Weight Heparin to Achieve Live Birth Following Unexplained Pregnancy Loss: A Meta-Analysis.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 489-489
Author(s):  
Simon Mantha ◽  
Kenneth A. Bauer ◽  
Jeffrey I Zwicker
Keyword(s):  
Molecular Weight ◽  
Board Of Directors ◽  
Low Molecular Weight Heparin ◽  
Pregnancy Loss ◽  
Recurrent Pregnancy Loss ◽  
Meta Analysis ◽  
Fetal Loss ◽  
Low Molecular Weight ◽  
Advisory Committees ◽  
History Of

Abstract 489 The management of recurrent pregnancy loss is uncertain. Some cohort studies have identified an association between inherited thrombophilias and recurrent or late-nonrecurrent pregnancy loss which has prompted investigators to evaluate the benefit of low molecular weight heparin to achieve live birth. A similar benefit for low molecular weight heparin has also been proposed independent of thrombophilia status. A recent Cochrane Review on this topic included the results of a single randomized trial in their analysis. As there are several recent randomized trials using low molecular weight heparin in women with recurrent pregnancy loss published in the obstetrical literature, we performed a meta-analysis to evaluate the benefit of low molecular weight heparin in women who experienced unexplained recurrent or late-nonrecurrent pregnancy loss. Methods: We conducted a meta-analysis of randomized controlled trials investigating the benefit of low molecular weight heparin versus a non-anticoagulant control arm in women with a history of ≥2 early pregnancy losses or ≥1 late pregnancy loss; we excluded women with antiphospholipid antibodies and those with an underlying cause of recurrent fetal loss, except for the hereditary thrombophilias. We planned to use random-effects analysis as the primary summary model due to the anticipated variations in enrollment criteria and interventions between the studies. Results: A total of 757 women were enrolled in five studies that satisfied the eligibility criteria. Using the random effects model, the risk ratio of fetal loss for low molecular weight heparin versus control was 0.49 (0.25-0.97 95% CI, P=0.04). There was significant heterogeneity observed between studies (Q-value was 15.59, P=0.004, and I2=74.33%). A priori, we identified the presence or absence of a hereditary thrombophilia as a potential source of heterogeneity. However, subgroup analysis of the studies according to the inclusion or exclusion of women with hereditary thrombophilia did not resolve the observed heterogeneity between studies. Exclusion of the only trial that enrolled women following a non-recurrent pregnancy loss improved the observed heterogeneity but diminished the apparent benefit of low molecular weight heparin (0.63, 95% CI 0.34-1.16, P=0.14). In this trial, the observed birth rate in the control arm was significantly lower than in the other two trials included in this meta-analysis with aspirin-only controls (29% versus 84% or 87% in aspirin-only arms, P<0.001). Conclusion: There is a trend for increased live births when using low molecular weight heparin for the prevention of recurrent pregnancy loss. However, considering the observed heterogeneity across studies, there is insufficient evidence to support the routine use of low molecular weight heparin to improve pregnancy outcomes in women with a history of pregnancy loss. Disclosures: Off Label Use: low molecular weight heparin to prevent pregnancy loss. Bauer:Bayer Healthcare: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; GSK: Speakers Bureau; GTC Biotherapeutics: Membership on an entity's Board of Directors or advisory committees. Zwicker:Sanofi-Aventis: Research Funding.

scholarly journals Comparative study of low dose aspirin versus combination of low dose aspirin and low molecular weight heparin in idiopathic recurrent pregnancy loss

2020 ◽  
Vol 9 (2) ◽  
pp. 512
Author(s):  
S. Bhanu Rekha ◽  
K. Sharath Chandra
Keyword(s):  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Pregnancy Loss ◽  
Birth Rate ◽  
Low Dose ◽  
Recurrent Pregnancy Loss ◽  
Live Birth Rate ◽  
Low Molecular Weight ◽  
Dose Aspirin ◽  
Low Dose Aspirin

Background: To compare the role of low dose aspirin versus combination of low dose aspirin and low molecular weight heparin in idiopathic recurrent pregnancy loss and assess the effectiveness of low dose aspirin and low molecular weight heparin in having a better obstetric outcome.Methods: This study was conducted in a private hospital in Mahabubnagar from June 2017 to May 2019. A total of 80 pregnant ladies who had previous 2 and or more pregnancy losses in the early (before 20 weeks) or late (after 20 weeks) pregnancy period was included in the study. 80 pregnant women with idiopathic/unexplained recurrent pregnancy loss were properly evaluated in regard to the history of previous period of gestation of loss, previous scans in regard to documentation of fetal pole and gestation, cardiac activity, anomaly scan and growth scan and any special investigations in previous pregnancies and present pregnancy.Results: A total 80 pregnant women with previous 2 and more unexplained pregnancy losses who were evaluated and found negative with major causes of pregnancy losses half of them (40) were treated with low dose aspirin alone and the other 40 women were treated with a combination of low dose aspirin (75 mg) and low molecular weight Heparin (20 mg) daily low molecular weight heparin till term. The aspirin alone group had 82.5% live birth rate and the combination group had 92.5% live birth rate which is quite satisfactory and more than the Aspirin alone group.Conclusions: Use of combination of low dose aspirin and low molecular weight heparin seems to be a good choice of drugs in treating the unexplained recurrent pregnancy losses than low dose aspirin alone.

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