Prevention of recurrent miscarriage for women with antiphospholipid antibody or lupus anticoagulant

Empson, Marianne; Lassere, Marissa; Craig, Jonathan C.; Scott, James R.

doi:10.1002/14651858.cd002859.pub2

Cited by 365 publications

(305 citation statements)

References 95 publications

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“…A HBPM apresenta diversas vantagens em relação à HNF: melhor efeito antitrombótico, menor incidência de sangramento, meia-vida mais longa e melhor biodisponibilidade 1 . Contudo, seu uso prolongado tem sido associado a efeitos colaterais maternos, incluindo a trombocitopenia, hemorragia e osteoporose 1,6 . Embora a hemorragia seja possível complicação da terapia anticoagulante, o uso da HBPM durante a gravidez está associado a redução na incidência de eventos hemorrágicos maternos, e não se associa a sangramentos fetais 26 .…”

Section: Discussionunclassified

“…Pressupõe-se que os agentes antiplaquetários, particularmente, a aspirina em baixas doses, podem impedir ou postergar o desenvolvimento da pré-eclâmpsia 6 , pois essa condição está associada à produção insuficiente de prostaciclinas e produção excessiva de tromboxano, vasoconstrictor que estimula a agregação plaquetária. Descreve-se redução do risco de 17% no desenvolvimento de pré-eclampsia com o uso de agentes antiplaquetários 3 .…”

Section: Discussionunclassified

“…A literatura sugere a utilização de terapia antitrombótica em mulheres que apresentam trombofilias, a fim de reduzir a formação de trombina e restaurar o balanço hemostático 5,6 . A anticoagulação é usada não apenas para tratar os eventos agudos e reduzir o risco de recorrência de tromboembolismo venoso (TEV) ou complicações em longo prazo, mas também para prevenir os eventos adversos durante a gravidez 7 .…”

Section: Introductionunclassified

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Eficácia de intervenção com enoxaparina baseada em sistema de pontuação nos desfechos perinatais de gestantes com trombofilias

Figueiró-Filho¹,

Oliveira²,

Breda³

et al. 2012

Rev. Bras. Ginecol. Obstet.

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ResumoOBJETIVO: Avaliar se a intervenção com heparina de baixo peso molecular (HBPM) -enoxaparina sódica -foi eficaz na melhora dos desfechos perinatais de mulheres com trombofillias com base em sistema de pontuação. MÉTODOS: Estudo prospectivo, não randomizado, não controlado, realizado em um Ambulatório de Gestação de Alto Risco, durante o período de novembro de 2009 a novembro de 2011. Foram incluídas gestantes com diagnóstico e intervenção terapêutica para trombofilias adquiridas e/ou hereditárias na gestação atual. Os dados obstétricos e perinatais das gestantes anteriores à intervenção foram comparados com os desfechos subsequentes à intervenção, sendo analisados estatisticamente através do teste do χ 2 , com correção de Yates, considerando significativos quando p<0,05. A dosagem inicial de HBPM foi norteada por sistema de pontuação, baseado no histórico clínico e gestacional das pacientes, além de exames de rastreamento de trombofilias adquiridas e/ou hereditárias. RESULTADOS: Foram incluídas 84 mulheres grávidas com 175 gestações anteriores ao diagnóstico, das quais 20,0% resultaram em morte fetal ou perinatal, 40,0% resultaram em abortamento, 17,7% desenvolveram pré-eclâmpsia ou eclâmpsia, 10,3% foram partos a termo e 29,7% partos pré-termo. Nas 84 gestações após a intervenção, 6,0% resultaram em morte fetal ou perinatal, 1,2% em abortamento, 4,8% desenvolveram pré-eclâmpsia/eclâmpsia, 22,6% em parto prematuro e 70,2% parto a termo. Observou-se redução significativa na taxa de óbito fetal ou perinatal (p<0,05) e abortos (p<0,0001), e aumento significativo (p<0,05) no número de nascidos vivos após a intervenção. CONCLUSÃO: A intervenção baseada na enoxaparina utilizando um sistema de pontuação em gestantes com trombofilia mostrou-se eficaz na melhora do desfecho perinatal. Abstract PURPOSES:To assess whether an enoxaparin-based intervention using a score system was effective in improving perinatal outcome in women with thrombophilia. METHODS: Study Design: Prospective, not randomized, uncontrolled, performed at a Clinic of High-Risk Pregnancy from November 2009 to November 2011. We included women with a diagnosis and therapeutic intervention for thrombophilia acquired and/or inherited in the current pregnancy. The obstetric and perinatal outcomes of pregnant women before the intervention were compared with outcomes after the intervention, and statistically analyzed using the χ 2 test with Yates correction, considered significant when p<0.05. The initial dose of low-molecular-weight Heparin (LMWH) was guided by a scoring system based on the clinical and gestational history of the patients and screening tests for acquired and/or inherited thrombophilia. RESULTS: We included 84 pregnant women with 175 pregnancies before diagnosis, 20.0% of which resulted in fetal ou perinatal death, 40.0% resulted in abortion, 17.7% developed preeclampsia/eclampsia, 10.3% resulted in full-term births, and 29.7% in premature births. In the 84 pregnancies after intervention, 6.0% resulted in fetal ou perinatal death, 1.2% in ...

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Section: Discussionunclassified

Section: Introductionunclassified

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Eficácia de intervenção com enoxaparina baseada em sistema de pontuação nos desfechos perinatais de gestantes com trombofilias

Figueiró-Filho¹,

Oliveira²,

Breda³

et al. 2012

Rev. Bras. Ginecol. Obstet.

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“…Literature includes many articles with mixed results concerning the effect of this adjuvant. One of the first Cochrane reviews about aspirin administration found that when combined with unfractionated heparin it may prevent recurrent miscarriage (RM) in women with anti-phospholipid syndrome [22]. On the contrary, in a more recent meta-analysis of 4 trials, authors showed that LBRs did not improve and early miscarriage rates did not decline by the addition of heparin to low-dose aspirin in women with congenital thrombophilia [23].…”

Section: Low-dose Aspirinmentioning

confidence: 99%

Adjuvants Therapies for Women Undergoing IVF: Is There Any Evidence of their Safety and Efficacy? An Updated Mini-Review

Fabozzi¹

2017

OGIJ

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In the last two decades a series of adjuvant therapies have been proposed to improve the success of IVF and most of them are currently prescribed even though the quality of scientific evidence supporting their efficacy in improving live birth rates after IVF is weak. The aim of this paper is to describe some of the therapies mostly used by women undergoing IVF such as dehydroepiandrosterone, testosterone, low-dose aspirin, low-molecular-weight heparin (LMWH), corticosteroids and endometrial scratching, and to assess the current evidence about their safety and efficacy. (Relative Risk (RR) 2.13; 95% CI 1.12-4.08). Similar results were obtained in subgroup analyses including randomized controlled trials and case-control studies (RR 2.57; 95% CI 1.43-4.63) and self-controlled studies (RR 3.95;). However, the effects of DHEA on oocyte retrieval, implantation, and abortion were not significant. The Cochrane review conducted in 2015 showed higher ongoing pregnancy rates or live birth rates following the pre-treatment with DHEA. Nevertheless, no benefit was observed when studies with high risk of bias were excluded [14,15]. Finally, a third meta-analysis analysing the effect of DHEA in women with DOR including a total of nine studies, four RCTs, four retrospective and one prospective concluded that clinical pregnancy rates were increased significantly in DOR patients who were pre-treated with DHEA (OR = 1.47, 95% CI: 1.09-1.99), whereas no differences were observed in the number of oocytes retrieved, the cancellation rate of IVF cycles and them is carriage rate between the cases and controls (WMD= −0.69, 95% CI: −2.18-0.81; OR = 0.74,95% CI: 0.51-1.08; OR = 0.34, 95% CI: 0.10-1.24). However, restricting the analysis to only RCTs, a non-significant difference in the clinical pregnancy rate was observed(OR = 1.08, 95% CI: 0.67-1.73) [15]. Keywords: Conclusive statementAlthough the effect of DHEA on improving ovarian response seems to be promising, there is insufficient evidence to recommend DHEA supplementation at this time. Furthermore, the long-term risk of DHEA administration remain unknown. More RCTs with large sample size are needed to obtain good quality evidence on its safety and efficacy. Testosterone (TT)Testosterone is a downstream molecule in the steroidal pathway from DHEA. It can be administered either trans-dermally or orally. Different RCTs report a beneficial effect of TT pre-treatment [16,17] and the meta-analysis from Bosdou et al. [18] analyzing both trials conducted by Massin et al. [16] and Kim et al. [17] reported that pretreatment with transdermal testosterone was associated with an increase in clinical pregnancy (risk difference (RD): +15%, 95% confidence interval (CI): +3 to +26%) and live birth rates (RD: +11%, 95% CI: +0.3 to +22%) in poor responders undergoing ovarian stimulation for IVF. A second meta-analysis conducted by also reported that testosterone-treated women achieved a significantly higher live birth rate (risk ratio, RR, 1.91, 95% CI 1.01 to 3.63), clinical pregnancy ra...

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“…Although bleeding can be a complication of anticoagulant therapy, the use of LMWH during pregnancy has been associated with a reduced incidence of bleeding events and an absence of maternal foetal bleeding. However, clinical and experimental studies have not demonstrated ample evidence of its safety and effects on the development of the embryo-foetus [1][2][3] .…”

Section: Introductionmentioning

confidence: 99%

Effects of enoxaparin and unfractionated heparin in prophylactic and therapeutic doses on the fertility of female Wistar rats

Figueiró-Filho

Aydos²,

Senefonte³

et al. 2014

Acta Cir. Bras.

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PURPOSE:To evaluate the effects of exposure of enoxaparin and unfractionated heparin (UFH) in prophylactic and therapeutic doses on the fertility rates of pregnant healthy Wistar rats. METHODS:Enoxaparin and UFH were administered in prophylactic doses 1 mg/Kg/day 72 UI/Kg/day, and in therapeutic doses at 2 mg/kg/day 400UI/Kg/day. The rats were divided into five groups. The number of live and dead foetuses was quantified. The uterine horns were dissected and the presence of early and late reabsorptions (abortions) was determined. A p<0.05 was considered statistically significant. RESULTS:We did not observe statistically significant differences between groups when comparing the average weight of the foetuses and placentas, rate of female VS males, rates of pre-implantation loss (RPL), rates of efficiency implantation (REI), rates of postimplantation loss (RPIL) and rates of foetal viability (RFV). CONCLUSIONS:There was no significant effect on fertility with the use of anticoagulant drugs in pregnant healthy Wistar rats.

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Prevention of recurrent miscarriage for women with antiphospholipid antibody or lupus anticoagulant

Abstract: Trusted evidence. Informed decisions. Better health.

Cited by 365 publications

References 95 publications

Eficácia de intervenção com enoxaparina baseada em sistema de pontuação nos desfechos perinatais de gestantes com trombofilias

Eficácia de intervenção com enoxaparina baseada em sistema de pontuação nos desfechos perinatais de gestantes com trombofilias

Adjuvants Therapies for Women Undergoing IVF: Is There Any Evidence of their Safety and Efficacy? An Updated Mini-Review

Effects of enoxaparin and unfractionated heparin in prophylactic and therapeutic doses on the fertility of female Wistar rats

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