title: Aspirin and low-molecular weight heparin combination therapy effectively prevents recurrent miscarriage in hyperhomocysteinemic women.
abstract: The management of recurrent pregnancy loss (RPL) still remains a great challenge, and women with polycystic ovarian syndrome (PCOS) are at a greater risk for spontaneous abortion. Treatment with low-molecular-weight heparin (LMWH) has become an accepted treatment option for women with RPL; however, the subgroup of women, who are likely to respond to LMWH, has not been precisely identified. The present study evaluated the efficacy of LMWH with reference to PCOS and associated metabolic phenotypes including hyperhomocysteinemia (HHcy), insulin resistance (IR) and obesity. This prospective observational study was conducted at Institute of Reproductive Medicine, Kolkata, India. A total of 967 women with history of 2 or more consecutive first trimester abortions were screened and 336 were selected for the study. The selected patients were initially divided on the basis of presence or absence of PCOS, while subsequent stratification was based on HHcy, IR and/or obesity. The subjects had treatment with aspirin during one conception cycle and aspirin-LMWH combined anticoagulant therapy for the immediate next conception cycle, if the first treated cycle was unsuccessful. Pregnancy salvage was the sole outcome measure. The overall rate of pregnancy salvage following aspirin therapy was 43.15%, which was mostly represented by normohomocysteinemic women, while the salvage rate was lower in the HHcy populations irrespective of the presence or absence of PCOS, IR, or obesity. By contrast, aspirin-LMWH combined therapy could rescue 66.84% pregnancies in the aspirin-failed cases. Logistic regression analyses showed that HHcy remained a significant factor in predicting salvage rates in the PCOS, IR, and obese subpopulations controlled for other confounding factors. With regard to pregnancy salvage, combined anticoagulant therapy with aspirin and LMWH conferred added benefit to those with HHcy phenotype.
authors.affiliation: Department of Infertility, Institute of Reproductive Medicine, Salt Lake City, Kolkata, West Bengal, India.
authors.forename: Pratip
authors.initials: P
authors.lastname: Chakraborty
authors.forename: Sayani
authors.initials: S
authors.lastname: Banerjee
authors.forename: Piyali
authors.initials: P
authors.lastname: Saha
authors.forename: Shyam Sundar
authors.initials: SS
authors.lastname: Nandi
authors.forename: Sunita
authors.initials: S
authors.lastname: Sharma
authors.forename: Sourendra K
authors.initials: SK
authors.lastname: Goswami
authors.forename: Baidyanath
authors.initials: B
authors.lastname: Chakravarty
authors.forename: Syed N
authors.initials: SN
authors.lastname: Kabir
mesh_terms: D000026:Abortion, Habitual / Q000188:drug therapy* / Q000473:pathology; D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D020138:Hyperhomocysteinemia / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D007333:Insulin Resistance; D050498:Live Birth; D009765:Obesity / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D001241:Aspirin
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