title: Prothrombotic state of patients with unexplained recurrent spontaneous abortion.
abstract: OBJECTIVE
  To determine the effect of aspirin and low-molecular-weight heparin (LMWH) for women affected by recurrent spontaneous abortion (RSA).
  
  
  METHODS
  The present prospective observational study included women with RSA (≥ 2 previous spontaneous abortions) and those without a history of RSA attending Ren Ji Hospital, Shanghai, China, between March 2011 and March 2014. D-dimer levels, auto-antibodies, and platelet aggregation in response to arachidonic acid (AA) and adenosine diphosphate (ADP) were monitored before pregnancy. Women with unexplained RSA and increased platelet aggregation received low-dose aspirin, and those with elevated D-dimer levels (> 0.75 μg/mL) received LMWH. Platelet aggregation in response to AA and ADP, and D-dimer levels were monitored during pregnancy.
  
  
  RESULTS
  Among 517 participants with RSA, 325 had unexplained RSA. Compared with 63 control patients, those with unexplained RSA and two, three, four, or at least five previous spontaneous abortions had increased platelet aggregation in response to AA (P < 0.05 for all comparisons) but not to ADP. Among 37 women with unexplained RSA who became pregnant, aspirin reduced platelet aggregation in response to AA (P < 0.001). LMWH reduced D-dimer levels during pregnancy (P < 0.001). Among 37 women with unexplained RSA who became pregnant and completed the study, 33 (89.2%) had a live birth.
  
  
  CONCLUSIONS
  Aspirin and LMWH maintained a lower thrombotic state and led to a high live birth rate among patients with unexplained RSA.
authors: Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
authors: Xuefeng
authors: X
authors: Lu
authors: Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
authors: Zhilan
authors: Z
authors: Liu
authors: Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
authors: Xiaoxin
authors: X
authors: Zhang
authors: Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
authors: Xiaomin
authors: X
authors: Kang
authors: Department of Clinical Laboratory, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
authors: Wei
authors: W
authors: Shen
authors: Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. Electronic address: zamzkh0526@126.com.
authors: Aimin
authors: A
authors: Zhao
mesh_terms: D000026:Abortion, Habitual / Q000097:blood / Q000503:physiopathology / Q000517:prevention & control*; D000328:Adult; D001241:Aspirin / Q000627:therapeutic use*; D002681:China; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D050498:Live Birth; D010974:Platelet Aggregation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011247:Pregnancy; D011446:Prospective Studies
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D010975:Platelet Aggregation Inhibitors; C036309:fibrin fragment D; D001241:Aspirin
keywords: Aspirin; D-dimer; Low-molecular-weight heparin; Platelet aggregation; Recurrent spontaneous abortion