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Low-Molecular-Weight Heparin for Pregnancy Complications

January 3, 2014

Low-Molecular-Weight Heparin for Pregnancy Complications

  1. David Green, MD, PhD

LMWH may be effective in preventing recurrent placenta-mediated complications such as pregnancy loss after 20 weeks.

  1. David Green, MD, PhD

Preeclampsia, late pregnancy loss, placental abruption, and small-for-gestational-age (SGA) babies are associated with thrombosis of placental vessels and placental infarction. These placental-mediated complications often recur in subsequent pregnancies, but whether these recurrences can be prevented by treatment with antithrombotic agents is unclear.

To examine the effectiveness of prophylactic low-molecular-weight heparin (LMWH) with or without aspirin versus no LMWH with or without aspirin in this setting, an international team of investigators performed a systemic review and meta-analysis of 6 randomized trials encompassing 848 pregnant women with prior placenta-mediated pregnancy complications.

The primary outcome of any recurrent preeclampsia, placental abruption, SGA baby (<10th percentile), or pregnancy loss after 20 weeks was observed in fewer patients receiving LMWH than in those receiving no LMWH (18.7% vs. 42.9%; P=0.01). However, there was heterogeneity among the trials, with only 4 of the 6 reporting significant risk reductions in the primary outcome. A combined secondary outcome of severe preeclampsia or early-onset preeclampsia, placental abruption, SGA baby (<5th percentile), or pregnancy loss after 20 weeks was also less frequent with LMWH (7.4% vs. 22.9%; P=0.0004). When examined individually, abruptions, pregnancy loss at <20 weeks, and neonatal deaths did not differ between the two groups.

Comment

If placental vessel thrombosis is the principal cause of several pregnancy complications, antithrombotic therapy should be an effective therapy. However, the results of randomized trials have been inconclusive, perhaps because of the heterogeneity of the populations being studied. Nevertheless, the observed benefit of low-molecular-weight heparin in patients with the most devastating outcomes, such as recurrent pregnancy loss after 20 weeks, support the authors' recommendation that antepartum prophylaxis be considered in such patients.

  • Disclosures for David Green, MD, PhD at time of publication Consultant / Advisory board Altor Bioscience Grant / research support NIH

Citation(s):

Reader Comments (1)

zhoufeng Physician, Critical Care Medicine, city suzhou of chia

If placental vessel thrombosis is the principal cause of several pregnancy complications, antithrombotic therapy should be an effective therapy. However, the results of randomized trials have been inconclusive, perhaps because of the heterogeneity of the populations being studied. Nevertheless, the observed benefit of low-molecular-weight heparin in patients with the most devastating outcomes, such as recurrent pregnancy loss after 20 weeks, support the authors' recommendation that antepartum prophylaxis be considered in such patients.

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