title: Antiphospholipid antibodies associated with recurrent pregnancy loss: prospective, multicenter, controlled pilot study comparing treatment with low-molecular-weight heparin versus unfractionated heparin.
abstract: OBJECTIVE
  To evaluate the use of low-molecular-weight heparin (LMWH) in combination with low-dose aspirin (LDA) for the treatment of antiphospholipid antibody (APA)-associated recurrent pregnancy loss and to compare the results with the use of unfractionated heparin (UFH) plus LDA.
  
  
  METHODS
  Prospective, controlled, multicenter pilot study.
  
  
  METHODS
  Two academically based reproductive health centers.
  
  
  METHODS
  Patients with three or more pregnancy losses and positive APA.
  
  
  METHODS
  Patients were treated with LMWH and LDA (n = 25) or UFH and LDA (n = 25).
  
  
  METHODS
  Fetal outcome and maternal complications from treatments were compared between the two treatment groups.
  
  
  RESULTS
  Of the 25 patients in the LMWH group, 21 (84%) delivered a viable infant and 4 (16%) miscarried. Of the 25 patients in the UFH group, 20 (80%) delivered a viable infant and 5 (20%) miscarried. These differences were not statistically significant. No major bleeding episodes occurred during pregnancy or at the time of delivery. No cases of deep venous thrombosis, thrombocytopenia, pre-eclampsia, gestational diabetes, or bone fractures were noted in either of the two groups.
  
  
  CONCLUSIONS
  In this pilot study, the use of LDA in combination with LMWH during pregnancy for the prevention of recurrent pregnancy loss in women with antiphospholipid syndrome seems to be as safe as UFH plus LDA. Large, randomized trials will be required to determine differences in outcome with LMWH and LDA compared with treatment with UFH combined with LDA in this group of patients.
authors.affiliation: Department of Obstetrics, Texas Tech University Health Sciences Center, El Paso, Texas, USA.
authors.forename: Luis S
authors.initials: LS
authors.lastname: Noble
authors.forename: William H
authors.initials: WH
authors.lastname: Kutteh
authors.forename: Nanette
authors.initials: N
authors.lastname: Lashey
authors.forename: Rodney D
authors.initials: RD
authors.lastname: Franklin
authors.forename: Juan
authors.initials: J
authors.lastname: Herrada
mesh_terms: D000026:Abortion, Habitual / Q000276:immunology* / Q000517:prevention & control*; D000328:Adult; D017152:Antibodies, Antiphospholipid / Q000097:blood*; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D010865:Pilot Projects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D011247:Pregnancy; D011248:Pregnancy Complications / Q000276:immunology / Q000517:prevention & control; D011256:Pregnancy Outcome; D047928:Premature Birth; D011446:Prospective Studies
chemical_list: D017152:Antibodies, Antiphospholipid; D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin