Heparin in pregnant women with previous placenta-mediated pregnancy complications: a prospective, randomized, multicenter, controlled clinical trial

Martinelli, Ida; Ruggenenti, Piero; Cetin, Irene; Pardi, Giorgio; Perna, Annalisa; Vergani, Patrizia; Acaia, Barbara; Facchinetti, Fabio; Sala, Giovanni Battista La; Bozzo, Maddalena; Rampello, Stefania; Marozio, Luca; Diadei, Olimpia; Gherardi, Giulia; Carminati, Sergio; Remuzzi, Giuseppe; Mannucci, Pier Mannuccio

doi:10.1182/blood-2011-11-391383

Cited by 116 publications

(117 citation statements)

References 29 publications

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“…Some randomized controlled trials determined that LMWH is a preventive treatment for placenta mediated pregnancy complications [27,28]. However, Martinelli et al suggested that LMWH should not be routinely administered to prevent recurrence of placenta-mediated pregnancy complications [29]. Badawy et al did not detect The present study has several limitations.…”

Section: Discussioncontrasting

confidence: 46%

The impact of low molecular weight heparin on obstetric outcomes among unexplained recurrent miscarriages complicated with methylenetetrahydrofolate reductase gene polymorphism

et al. 2017

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Objectives:The association between methylenetetrahydrofolate reductase gene polymorphisms and unexplained recurrent miscarriage is elusive. The recommendations for improving pregnancy outcomes in these patients keep changing based on the available evidence. The aim of this study is to analyze the impact of low molecular weight heparin on obstetric outcomes of recurrent miscarriage patients complicated with methylenetetrahydrofolate reductase gene polymorphism. Material and methods:We reviewed medical records of 121 patients with a history of recurrent miscarriage complicated by methylenetetrahydrofolate reductase gene polymorphisms, retrospectively. From among them, 68 patients were treated only with folic acid and iron. The remaining 53 patients were treated with folic acid, iron and prophylactic doses of low molecular weight heparin. The subsequent pregnancy outcomes of these patients were noted. Results:The live birth rate was higher in patients with anticoagulant therapy than in patients without anticoagulant therapy (48.5% vs. 69.8%, respectively, p: 0.015) and the congenital anomaly rate was lower in anticoagulant therapy group (17.6% vs. 3.8%, respectively, p: 0.022). The other obstetric outcomes were found to be similar between the two groups. Conclusions:The current study demonstrated that low molecular weight heparin improved the live birth rates among unexplained recurrent miscarriage patients complicated with methylenetetrahydrofolate reductase gene polymorphisms. However, the routine use of low molecular weight heparin did not improve the late pregnancy complications in these selected patients in the eastern region of our country. Further studies are needed to discriminate the effect of anticoagulation on the live birth rate of each of methylenetetrahydrofolate reductase gene polymorphism type.

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Section: Discussioncontrasting

confidence: 46%

The impact of low molecular weight heparin on obstetric outcomes among unexplained recurrent miscarriages complicated with methylenetetrahydrofolate reductase gene polymorphism

et al. 2017

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“…Only a small number of women with inherited thrombophilia were included in these studies (HA -BENOX study 24 women, SPIN study 10 women), with a nonsignificant increase in live birth rate in throm bophilic women treated with enoxiparin. Contrary to these findings, the two most recently published studies failed to demonstrate a beneficial effect of thromboprophylaxis on the pregnancy outcome in thrombophilic women with previous pregnancy complications other than recurrent miscarriages (61,62).…”

Section: Pregnancycontrasting

confidence: 39%

An Integrative Approach to the Patient with Thrombophilia / SVEOBUHVATNI PRISTUP BOLESNIKU SA TROMBOFILIJOM

Mitić¹

2014

Journal of Medical Biochemistry

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SummaryVenous thromboembolism (VTE) is a multifactorial disease that results from a conjunction of several risk factors, both inherited and acquired. The younger the person, the more risk factors are required to cause the disease. Since 1937, when the term thrombophilia was coined by Nygaard and Brown, and 1965 when it was used for the first time by Egeberg, a substantial increase in the percentage of patients with VTE and underlying thrombophilia has been reported, particularly after the discovery of the most common thrombophilic mutations, FV Leiden and FII G20210A. Presence of thrombophilia could be detected in as many as 50% of all patients with VTE. Thrombophilia testing has increased lately not only in patients with thromboses but also for other indications, however, whether the results will help in the clinical management of the patients is still unclear. Thrombo philia testing is most commonly performed in young patients with VTE, patients with recurrent episodes of VTE or with thromboses at unusual sites and in persons with positive family history. Whether the presence of thrombophilia influences the clinical management of the patient remains controversial. Patients with VTE and the recognized risk factors such are surgery, trauma, immobilization, pregnancy and the puerperium are at very low risk for recurrence, but prediction of the recurrence of VTE based on the presence of thrombophilia has not been sufficiently explored. Presence of clinical risk factors should be integrated in the strategy of VTE risk assessment. Since many risk factors, such as obesity, hypertension, dyslipidemia, diabetes and smoking are common for both arterial and venous thromboses, it has been suggested that VTE should be considered as part of a pancardiovascular syndrome, along with coronary artery disease, Kratak sadr`ajVenska tromboembolijska bolest (VTE) nastaje kao rezultat udru`enog delovanja brojnih faktora rizika, kako naslednih tako i ste~enih. U~estalost VTE je direktno povezana sa staro{}u, tako da je u mla|em uzrastu neophodno udru`eno delovanje vi{e faktora rizika za nastanak venske tromboze. Prisustvo trombofilije se mo`e utvrditi kod oko polovine bolesnika sa VTE. Dijagnostika trombofilije je sve ~e{}a u svako dnevnom laboratorijskom radu, ne samo kod bo lesnika sa trombozama ve} i za druge indikacije kao {to su komplikacije trudno}e izazvane o{te}enjem placentalne vasku larizacije, a da nije u potpunosti razja{njeno da li }e prisustvo trombofilije uticati na dalji tok le~enja i sveobuhvatni pristup bolesniku. Naj~e{}e indikacije za ispitivanje trombofilije su tromboze u mla |em uzrastu, recidivi venskih tromboza, tromboze na ne uo bi~ajenim mestima kao i postojanje tromboza kod vi{e ~la no va porodice. Dijagnostika trombofilije se naje{}e ko risti kao pomo} u proceni rizika za nastanak recidiva VTE, mada je dosada{njim ispitivanjima pokazano da samo te{ke trom bo filije, kao {to su deficit inhibitora koagulacije, homo zigotni oblik mutacije FV Leiden ili udru`eni heterozigoti za FV Lei den i FII G20210A, predst...

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“…However, a recent trial, Heparin in Pregnant women with adverse Pregnancy outcome to improve the rate of successful pregnancy (HAPPY trial), failed to show any benefit of LMWH in preventing these adverse events, including pregnancy loss [23]. Subsequent studies have, however, shown that treatment with LMWH appeared beneficial in preventing the more severe forms of these adverse events in a subgroup of women with thrombophilia.…”

Section: Treatment Of Recurrent Miscarriage In Thrombophiliamentioning

confidence: 96%

Recurrent pregnancy loss and thrombophilia

Motha

Palihawadana

Perry³

2014

Ceylon Med. J.

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Heparin in pregnant women with previous placenta-mediated pregnancy complications: a prospective, randomized, multicenter, controlled clinical trial

Cited by 116 publications

References 29 publications

The impact of low molecular weight heparin on obstetric outcomes among unexplained recurrent miscarriages complicated with methylenetetrahydrofolate reductase gene polymorphism

The impact of low molecular weight heparin on obstetric outcomes among unexplained recurrent miscarriages complicated with methylenetetrahydrofolate reductase gene polymorphism

An Integrative Approach to the Patient with Thrombophilia / SVEOBUHVATNI PRISTUP BOLESNIKU SA TROMBOFILIJOM

Recurrent pregnancy loss and thrombophilia

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