Enoxaparin versus unfractionated heparin in the management of recurrent abortion secondary to antiphospholipid syndrome.
OBJECTIVE
To determine whether low molecular weight heparin (LMWH) plus low-dose aspirin (LDA) is comparable in efficacy and safety to unfractionated heparin (UFH) plus LDA in the management of pregnant women with a history of recurrent spontaneous abortion secondary to antiphospholipid syndrome (APS).


METHODS
In a randomized prospective study, 60 women with a history of 3 or more consecutive spontaneous abortions and positive antiphospholipid antibodies were assigned in equal numbers to receive either UFH (5000 units, twice daily) plus LDA, or LMWH (enoxaparin 40 mg, once daily) plus LDA as soon as pregnancy was diagnosed.


RESULTS
Twenty-four women in the LMWH group (80%) and 20 women in the UFH group (66.67%) delivered a viable infant (P = 0.243). There were no significant differences in pregnancy complications or neonatal morbidity between the 2 groups. There were no incidences of excessive bleeding, thrombocytopenia, or osteoporotic fractures in either group.


CONCLUSIONS
LMWH plus LDA was successfully used as an alternative to UFH plus LDA in the management of recurrent abortion secondary to APS. The results highlight the need for a larger randomized controlled trial to determine whether LMWH plus LDA should be the treatment of choice for recurrent abortion secondary to APS. Clinicaltrials.gov NCT01051778.
Department of Obstetrics and Gynecology, Faculty of medicine, Cairo University, Cairo, Egypt. umfrfouda@yahoo.com
Usama M
UM
Fouda
Ahmed M
AM
Sayed
Abdel-Megid A
AM
Abdou
Dalia I
DI
Ramadan
Iman M
IM
Fouda
Mahmoud M
MM
Zaki
D000026:Abortion, Habitual / Q000188:drug therapy* / Q000209:etiology; D000328:Adult; D017152:Antibodies, Antiphospholipid / Q000097:blood; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D016736:Antiphospholipid Syndrome / Q000150:complications*; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D017984:Enoxaparin / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D058866:Osteoporotic Fractures / Q000139:chemically induced; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000139:chemically induced; D011256:Pregnancy Outcome; D013921:Thrombocytopenia / Q000139:chemically induced; D016896:Treatment Outcome
D017152:Antibodies, Antiphospholipid; D000925:Anticoagulants; D017984:Enoxaparin; D010975:Platelet Aggregation Inhibitors; D006493:Heparin; D001241:Aspirin