Low-molecular-weight heparin for pregnancy complications

Pre-eclampsia, fetal growth restriction, placental abruption, and recurrent miscarriage are common placenta-mediated pregnancy complications. They have overlapping pathological features including deficient placentation, microvascular thrombosis, placental infarction, and an association with thrombophilia, 1 Greer IA Brenner B Gris JC Antithrombotic treatment for pregnancy complications: which path for the journey to precision medicine?. Br J Haematol. 2014; 165: 585-599 Crossref PubMed Scopus (36) Google Scholar , 2 Robertson L Wu O Langhorne P et al. Thrombosis: Risk and Economic Assessment of Thrombophilia Screening (TREATS) study. Thrombophilia in pregnancy: a systematic review. Br J Haematol. 2006; 132: 171-196 Crossref PubMed Scopus (686) Google Scholar , 3 Rodger MA Betancourt MT Clark P et al. The association of factor V Leiden and prothrombin gene mutation and placenta-mediated pregnancy complications: a systematic review and meta-analysis of prospective cohort studies. PLoS Med. 2010; 7: e1000292 Crossref PubMed Scopus (183) Google Scholar implicating coagulation activation as a disease mechanism. Antithrombotic treatment has been shown to improve the outcome of antiphospholipid syndrome manifested as recurrent pregnancy loss, and low-dose aspirin provides a modest risk reduction in women with previous pre-eclampsia. 1 Greer IA Brenner B Gris JC Antithrombotic treatment for pregnancy complications: which path for the journey to precision medicine?. Br J Haematol. 2014; 165: 585-599 Crossref PubMed Scopus (36) Google Scholar These findings provide a biological plausibility for treating women who have had previous placenta-mediated pregnancy complications with antithrombotic drugs in subsequent pregnancies. Low-molecular-weight heparin and recurrent placenta-mediated pregnancy complications: a meta-analysis of individual patient data from randomised controlled trialsLow-molecular-weight heparin does not seem to reduce the risk of recurrent placenta-mediated pregnancy complications in at-risk women. However, some decreases in event rates might have been too small for the power of our study to explore. Full-Text PDF