Enoxaparin versus unfractionated heparin in the management of recurrent abortion secondary to antiphospholipid syndrome

Fouda, Usama M.; Sayed, Ahmed El; Abdou, Abdel-Megid A.; Ramadan, Dalia Ibrahim; Fouda, Iman M.; Zaki, M.M.

doi:10.1016/j.ijgo.2010.09.010

Cited by 66 publications

(64 citation statements)

References 22 publications

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“…[107] A small trial showed comparable results with LMWH plus aspirin as an alternative to unfractionated heparin and aspirin in the management of recurrent miscarriage secondary to APS. [108] The consensus is combination of low molecular weight heparin and aspirin is superior to aspirin alone in achieving more live births. Therefore, it is recommended treatment for recurrent miscarriages with antiphospholipid syndrome[109110] (Evidence level I).…”

Section: Methodsmentioning

confidence: 99%

Evidence-based management of recurrent miscarriages

2014

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Recurrent miscarriages are postimplantation failures in natural conception; they are also termed as habitual abortions or recurrent pregnancy losses. Recurrent pregnancy loss is disheartening to the couple and to the treating clinician. There has been a wide range of research from aetiology to management of recurrent pregnancy loss. It is one of the most debated topic among clinicians and academics. The ideal management is unanswered. This review is aimed to produce an evidence-based guidance on clinical management of recurrent miscarriage. The review is structured to be clinically relevant. We have searched electronic databases (PubMed and Embase) using different key words. We have combined the searches and arranged them with the hierarchy of evidences. We have critically appraised the evidence to produce a concise answer for clinical practice. We have graded the evidence from level I to V on which these recommendations are based.

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Section: Methodsmentioning

confidence: 99%

Evidence-based management of recurrent miscarriages

2014

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“…related at least in part to placental thrombosis. [72][73][74][75][76][77][78][79] Given the preferable profile of LMWH to UFH from a safety and side-effect standpoint, many practitioners choose to administer prophylactic-dose LMWH.…”

Section: Antiphospholipid Antibody Syndromementioning

confidence: 99%

Diagnosis, Treatment, and Prevention of Venous Thromboembolism in Pregnancy

Marshall

2014

Postgraduate Medicine

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Pregnancy and the puerperium put women at increased risk of venous thromboembolism (VTE) due to both baseline maternal risk factors and the development of pregnancy-related prothrombotic anatomic and physiologic changes. Pregnant women are at an approximately 5-fold increased risk of VTE compared with nonpregnant women, and the risk of VTE increases further (to ≥ 20-fold) in puerperium; risk remains increased until approximately 12 weeks postpartum. Pregnancy-related VTE accounts for about 10% of maternal deaths in the developed world. Clinicians should promptly evaluate any signs or symptoms suspicious for VTE, generally starting with ultrasound of the lower extremities. For treatment of women with established VTE, low molecular weight heparins (LMWHs) are preferred due to a favorable safety and efficacy profile. Unfractionated heparin (UFH) and potentially fondaparinux are alternatives. Warfarin should be avoided in the antepartum period due to teratogenicity, and the non-vitamin K oral anticoagulants are currently not recommended due to the lack of data. Low molecular weight heparin, UFH, and warfarin are all acceptable in the postpartum period and for breast-feeding women, but the non-vitamin K oral anticoagulants should be avoided. Prophylaxis (generally with LMWH or in some cases UFH) is recommended for women at highest risk of pregnancy-related VTE, such as those with inherited thrombophilias and a strong family or personal history of VTE. Prophylaxis with LMWH and aspirin is recommended for women with antiphospholipid syndrome. Clinicians should engage in multidisciplinary discussion, particularly around the time of delivery, to manage the details of anticoagulation in their pregnant patients.

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“…Low-molecular-weight heparin has demonstrated similar efficacy to unfractionated heparin in prospective studies on obstetric APS. 62,63 In patients refractory to these treatment strategies, an additional use of steroids, intravenous immunoglobulin, and plasmapheresis has shown benefit in case reports.…”

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confidence: 99%