LMWH have no place in recurrent pregnancy loss: debate-against the motion.
The SPIN and ALIFE intervention trials apparently support that LMWHs should not be advocated in patients with idiopathic RPL. There are however some concerns. Epidemiology implies that most of the included patients shared recurrent regulatory embryonic losses associated with isolated cytogenetics defects, a dominant good prognosis entity which doesn't have to be treated. The real PL illness, idiopathic foetal loss with normal karyotypes, was a minority. Primary and secondary RPL cases were included, whose prognostic, applied to non-sporadic PLs, cannot be similar. Thrombophilic patients were a minority, despite existing data suggesting a LMWH beneficial effect. LMWHs were associated with LDA, previously suspected to be deleterious in PL patients with thrombophilia. The two indubitably planned-to-be negative trials will positively contribute to limit aberrant LMWH treatments in non-selected RPL women cared without comprehensive clinical categorisation. This is not the real clinical target for LMWHs, which still has to be fully investigated.
Department of Haematology, University Hospital, Nîmes, France. jean.christophe.gris@chu-nimes.fr
Jean-Christophe R
JC
Gris
D000026:Abortion, Habitual / Q000139:chemically induced*; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use; D020964:Embryo Loss / Q000188:drug therapy*; D005260:Female; D005333:Fetus / Q000187:drug effects; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D019851:Thrombophilia / Q000188:drug therapy
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D001241:Aspirin