Anticoagulant therapy and pregnancy

Abstract

Low dose aspirin therapy is one of the anticoagulant treatments used during pregnancy. Anticoagulant agents may be useful for several disorders, such as recurrent miscarriage, preeclampsia, fetal growth restriction and infertility. However, it is unclear whether anticoagulant therapy can increase the live birth rate in all of these cases. Recent data suggest that a low-dose aspirin and heparin combination therapy is effective in the prevention of recurrent pregnancy loss in women with antiphospholipid syndrome. Thrombogenic diseases, for example, protein C deficiency, protein S deficiency, factor XII deficiency and hyperhomocysteinemia, may cause pregnancy loss. The etiology of recurrent miscarriage is often unclear and may be multifactorial, with much controversy regarding diagnosis and treatment. Although 70% of recurrent pregnancy losses are unexplained, anticoagulant therapy is effective in maintaining pregnancy without antiphospholipid antibody syndrome. We conclude that a low-dose aspirin and heparin combination therapy can be useful for unexplained cases of recurrent pregnancy loss without antiphospholipid antibody syndrome. (Reprod Med Biol 2008; 7: 1-10)

Aspirin and heparin in the treatment of recurrent spontaneous abortion associated with antiphospholipid antibody syndrome: A systematic review and meta‑analysis

“…Anticoagulant therapy is mainly used for pregnant patients with a history of abortion and positive APA ( 54 ). The primary goal of this therapy is to protect the mother from thrombosis and reduce the risk of miscarriage ( 55 ). Aspirin can inhibit platelet aggregation, increase prostacyclin levels and has an anticoagulant effect ( 56 , 57 ).…”

Clinical guidance for peripartum management of patients with hereditary thrombophilia

“…96 Another report suggested the possibility that AT, PC, and PS deficiencies are involved in recurrent pregnancy loss in the second trimester of pregnancy and later. 97 It is also reported that PS p.K196E, which is exclusive to Japanese, is not a risk factor for recurrent pregnancy loss and that there were no significant differences in low PS activity and subsequent childbearing rate. 34,98 With respect to decreased PS activity, there are also studies on acquired decreases due to PS antibodies rather than to a genetic predisposition.…”

“…Most are limited studies, and there are many conflicting reports stating that it is or is not involved in recurrent pregnancy loss. 33,34,[89][90][91][92][93][94][95][96][97][98] Studies in Western countries have examined mutations such as FV Leiden and prothrombin 20210G > A that are not identified in Japanese. Therefore, investigations of Japanese people are limited and few reports have been published.…”

“…Therefore, investigations of Japanese people are limited and few reports have been published. 34,[96][97][98] Recently, the inability to carry a pregnancy to full term has been reported in women with homozygous AT Budapest 3. 25 There are also reports, although few, suggesting that measurement of factor XII (FXII) is meaningful.…”

“…89 In addition, although the cause is unknown, with consideration of the abortion history of the individual, complications in a previous pregnancy, and background, some forms of treatment, including an expected placebo effect, have been successful in a few cases. 89,97 There is also a report from a survey of pregnant and nursing women with PS deficiency who have histories of abortion in Japan, which found that the rate of successful pregnancy was significantly higher in a group using anticoagulant therapy than in an untreated group. 107 Based on this and other findings, UFH monotherapy, monotherapy with low doses of aspirin (LDA), an antiplatelet drug, and combination therapy with UFH are frequently used.…”