title: Low-molecular-weight heparin versus low-dose aspirin in women with one fetal loss and a constitutional thrombophilic disorder.
abstract: The prospective evaluation of the effect of thromboprophylaxis in women with one unexplained pregnancy loss from the 10th week of amenorrhea was performed. A total of 160 patients with heterozygous factor V Leiden mutation, prothrombin G20210A mutation, or protein S deficiency were given 5 mg folic acid daily before conception, to be continued during pregnancy, and low-dose aspirin 100 mg daily or low-molecular-weight heparin enoxaparin 40 mg was taken from the 8th week. Twenty-three of the 80 patients treated with low-dose aspirin and 69 of the 80 patients treated with enoxaparin had a healthy live birth (odds ratio [OR], 15.5; 95% confidence interval [CI], 7-34, P <.0001). Enoxaparin was superior to low-dose aspirin in each subgroup defined according to the underlying constitutional thrombophilic disorder. An associated protein Z deficiency and/or positive antiprotein Z antibodies were associated with poorer outcomes. The neonate weight was higher in the women successfully treated with enoxaparin, and neonates small for gestational age were more frequent in patients treated with low-dose aspirin. No significant side effects of the treatments could be evidenced in patients or newborns. As there is no argument to prove that low-dose aspirin may have been deleterious, these results support enoxaparin use during such at-risk pregnancies.
authors.affiliation: Hematology Laboratory, University Hospital, Nîmes, France. jcgris@chu-nimes.fr
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Gris
authors.forename: Eric
authors.initials: E
authors.lastname: Mercier
authors.forename: Isabelle
authors.initials: I
authors.lastname: Quéré
authors.forename: Géraldine
authors.initials: G
authors.lastname: Lavigne-Lissalde
authors.forename: Eva
authors.initials: E
authors.lastname: Cochery-Nouvellon
authors.forename: Médéric
authors.initials: M
authors.lastname: Hoffet
authors.forename: Sylvie
authors.initials: S
authors.lastname: Ripart-Neveu
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Tailland
authors.forename: Michel
authors.initials: M
authors.lastname: Dauzat
authors.forename: Pierre
authors.initials: P
authors.lastname: Marès
mesh_terms: D001241:Aspirin / Q000008:administration & dosage*; D001724:Birth Weight; D017984:Enoxaparin / Q000008:administration & dosage; D005260:Female; D005313:Fetal Death / Q000517:prevention & control*; D005492:Folic Acid / Q000008:administration & dosage; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage*; D006801:Humans; D016017:Odds Ratio; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy / Q000517:prevention & control*; D011256:Pregnancy Outcome; D019851:Thrombophilia / Q000097:blood / Q000188:drug therapy*
chemical_list: D017984:Enoxaparin; D006495:Heparin, Low-Molecular-Weight; D005492:Folic Acid; D001241:Aspirin