Dalteparin and low-dose aspirin in the prevention of adverse obstetric outcomes in women with inherited thrombophilia.
OBJECTIVE
To evaluate the benefit of treatment with dalteparin and low-dose aspirin (ASA) in the prevention of obstetric complications in women with inherited thrombophilia.


METHODS
A retrospective chart review identified women who had had at least one pregnancy complicated by severe early-onset preeclampsia, placental abruption, fetal growth restriction (FGR), or fetal death. The following inherited thrombophilias were included: deficiencies of antithrombin, protein C, or protein S, and mutations of factor V Leiden (G1691A), factor II (G20210A), or methylenetetrahydrofolate reductase C677T.


RESULTS
The records of 43 women with 110 pregnancies were included in the study. Anticoagulant prophylaxis was administered using dalteparin in 13 pregnancies, ASA with dalteparin in 26, and ASA alone in 11. Dalteparin alone and ASA alone showed equivalent effects in preventing preeclampsia and FGR. Combined dalteparin and ASA significantly decreased the risk of preeclampsia (odds ratio [OR] 0.80; 95% confidence intervals [CI] 0.70-0.91, P = 0.001) and FGR (OR 0.70; 95% CI 0.60-0.82, P = 0.001).


CONCLUSIONS
Data from this retrospective cohort study suggest that combined treatment with dalteparin and ASA decreases the risk of preeclampsia by 20% and the risk of FGR by 30% in women with inherited thrombophilia.
Leduc
Line
L
Department of Obstetrics and Gynecology, Sainte-Justine Hospital, University of Montreal, Montreal QC.
Dubois
Emmanuelle
E
Takser
Larissa
L
Rey
Evelyne
E
David
Michèle
M
D000037:Abruptio Placentae / Q000517:prevention & control; D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D017985:Dalteparin / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005313:Fetal Death / Q000517:prevention & control; D005317:Fetal Growth Retardation / Q000517:prevention & control; D006801:Humans; D011225:Pre-Eclampsia / Q000517:prevention & control; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000517:prevention & control*; D012189:Retrospective Studies; D019851:Thrombophilia / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome
D000925:Anticoagulants; D001241:Aspirin; D017985:Dalteparin