Low-molecular-weight heparin combined with aspirin in pregnant women with thrombophilia and a history of preeclampsia or fetal growth restriction: a preliminary study.
OBJECTIVE
To assess the prevalence of haemostatic abnormalities in patients with an obstetric history of preeclampsia and/or fetal growth restriction and documented thrombophilia, and to evaluate the effects of low-molecular-weight heparin (LMWH) and aspirin on pregnancy outcome.


METHODS
A total of 276 patients with a history of preeclampsia and/or fetal growth restriction were tested for the presence of coagulation abnormalities and anticardiolipin antibodies (ACA). Ninety patients with preeclampsia and 15 patients with isolated fetal growth restriction had haemostatic abnormalities. Twenty-six patients with coagulation abnormalities: protein S-deficiency, activated protein C (APC) resistance and/or > or =15 ACA GPL and/or MPL had a subsequent pregnancy and were treated with aspirin in combination with LMWH. Their pregnancy outcome was compared with all patients having a subsequent pregnancy from the same cohort without abnormalities, or <15 ACA GPL and/or MPL who received aspirin (n=19).


RESULTS
In subsequent pregnancies birth weight of babies born to patients with an unequivocal coagulation abnormality (i.e., protein S-deficiency, APC resistance, or ACA titres > or =15 GPL and/or MPL), were higher than in the group with no disorders or <15 ACA GPL and/or MPL (P=0.019).


CONCLUSIONS
In this preliminary study, LMWH appears to have a favourable effect on the pregnancy outcome of women with a history of preeclampsia and/or fetal growth restriction and documented thrombophilia. Randomised trials are required.
Department of Obstetrics and Gynecology, Free University Hospital, Amsterdam, The Netherlands.
N
N
Riyazi
M
M
Leeda
J I
JI
de Vries
P C
PC
Huijgens
H P
HP
van Geijn
G A
GA
Dekker
D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005317:Fetal Growth Retardation / Q000150:complications*; D005865:Gestational Age; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D011225:Pre-Eclampsia / Q000150:complications* / Q000517:prevention & control; D011247:Pregnancy; D011248:Pregnancy Complications; D011250:Pregnancy Complications, Hematologic / Q000188:drug therapy; D012008:Recurrence; D019851:Thrombophilia / Q000150:complications* / Q000188:drug therapy
D006495:Heparin, Low-Molecular-Weight; D001241:Aspirin