RETRACTED ARTICLE: Low-molecular weight heparin in patients with recurrent early miscarriages of unknown aetiology

Abstract

The aim of this randomised prospective study was to assess the efficacy of early thromboprophylaxis with low-molecular weight heparin (LMWH) in women with a history of recurrent first trimester spontaneous abortion or miscarriages without identifiable causes vs no treatment. The study comprised of 340 women with unexplained spontaneous recurrent miscarriages. Patients in group A were prescribed LMWH (Enoxaparin sodium 0.2 ml, 20 mg, once daily subcutaneously) from the time of confirmation of fetal viability by ultrasonography until 34 weeks' gestation, and folic acid tablets 0.5 mg daily until 13 weeks' gestation. Patients in group B were given folic acid tablets 0.5 mg daily until 13 weeks' gestation. Termination of pregnancy was the primary outcome. There was a significant difference in the incidence of both early (4.1% vs 8.8%) and late miscarriages (1.1% vs 2.3%) in group A than in group B, respectively. There were no differences between both groups as regards the occurrence of pre-eclampsia, placental abruption, caesarean delivery, intra-partum bleeding or ecchymosis at operative wounds. There were no differences in most of the neonatal values between both groups. However, the mean birth weight was significantly higher in group A. LMWH seems to be a safe drug and effective in significantly reducing the incidence of recurrent miscarriages of unknown aetiology when given in the first trimester and continued throughout pregnancy.

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

“…Two clinical trials compared congenital abnormalities in RM patients and they reported similar rates between patients that did and did not receive LMWH [20,21]. In our study, congenital abnormalities were more frequent in LMWH-free group (group A).…”

Serum hCG-β levels of postovulatory day 12 and 14 with the sequential application of hCG-β fold change significantly increased predictability of pregnancy outcome after IVF-ET cycle

“…Application of this sequential data to clinical practice could aid the early prediction of pregnancy outcome, and appropriate and timely counseling of patients. Particularly, earlier prediction of pregnancy outcome could provide appropriate reference to health care providers to establish a treatment plan for recurrent pregnancy losses or implantation failures [43][44][45], initiate earlier management of high risk pregnancies, and precise follow-up of abnormal pregnancies. Therefore, early pregnancy biomarkers such as POD 12 hCG-β level and its fold change based on embryonic age could provide a predictive and appropriate reference to both health care providers and patients and assist earlier management and precise follow-up of women with abnormal or high risk pregnancies.…”

Enoxaparin for prevention of unexplained recurrent miscarriage: a multicenter randomized double-blind placebo-controlled trial

“…by guest www.bloodjournal.org From analyzed about the effect of heparin alone vs no treatment, when excluding studies with a high risk of bias. 16,17 The use of LMWH was supported by some studies in which a basal prothrombotic state outside of pregnancy was measured in women with previous recurrent miscarriage and without known thrombophilia. [24][25][26] In addition, heparin and LMWH have other biological properties that could be critical for implantation and placentation.…”

“…[15][16][17][18][19][20][21][22] Only one trial was placebo-controlled (the ALIFE study), a randomized trial among all-comer women (;85% had a negative thrombophilia workup), which resulted in a turning point: the lack of any beneficial effect of aspirin was clearly demonstrated. In addition, the use of openlabel LMWH combined with aspirin in a third intervention arm did not show any improvement in live-birth rates vs oral placebo.…”