Dalteparin for the Prevention of Recurrence of Placental-Mediated Complications of Pregnancy in Women Without Thrombophilia: A Pilot Randomized Controlled Trial

Rey, Évelyne; Garneau, Philippe; David, Michèle; Gauthier, Robert; Leduc, Line; Michon, Nicole; Morin, Francine; Demers, Christine; Kahn, Susan R.; Magee, Laura A.; Rodger, Marc

doi:10.1097/01.ogx.0000350208.28114.49

Cited by 38 publications

(64 citation statements)

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“…75,76 Moreover, with the recent publication of a randomized controlled trial showing that low-molecular weight heparin can also decrease the recurrence of severe preeclampsia, future studies should compare low-dose aspirin to heparin in highrisk populations. 77 Based on the results of this review, current evidence indicates that low-dose aspirin started in early pregnancy may reduce the incidence of preeclampsia, IUGR and preterm birth in women identified at moderate or high risk for preeclampsia. Of note, because most studies in the 16-weeks-or-less subgroup were small and included women at high risk for preeclampsia, and because we found a potential publication bias, we believe that a large randomized controlled trial should be carrying out to validate our results.…”

Section: Bujold Preeclampsia and Iugr Prevention With Aspirin Obstementioning

confidence: 95%

Prevention of Preeclampsia and Intrauterine Growth Restriction With Aspirin Started in Early Pregnancy

Bujold

Roberge

Lacasse

et al. 2010

Obstetrics &Amp; Gynecology

984

659

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Section: Bujold Preeclampsia and Iugr Prevention With Aspirin Obstementioning

confidence: 95%

Prevention of Preeclampsia and Intrauterine Growth Restriction With Aspirin Started in Early Pregnancy

Bujold

Roberge

Lacasse

et al. 2010

Obstetrics &Amp; Gynecology

984

659

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“…For example, Gris et al [8] showed significant reduction in adverse outcome in women with known thrombophilias and fetal loss after they had been treated with LMWH compared with those treated with aspirin during their subsequent pregnancy [8]. In a pilot randomized controlled trial, Rey et al [15] showed a significant decrease in the rate of placental-mediated complications that led to adverse outcome among women who were negative for thrombophilias and who received LMWH treatment. Antiplatelet drugs, such as aspirin, were also shown to slightly reduce the incidence of preeclampsia, FGR and stillbirth [21].…”

Section: Discussionmentioning

confidence: 96%

“…One randomized study showed an advantage in administering LMWH in pregnant women who had experienced placental-mediated complications in an earlier pregnancy, but whose workup for thrombophilias had been negative [15]. The issue of whether all women with a similar history should be treated with LMWH remains unresolved.…”

Section: Introductionmentioning

confidence: 98%

“…These pregnancy complications are also associated with typical placental vasculopathy, such as infarcts and thrombosis in women with and without thrombophilias [5][6][7]. Several studies have reported a high-recurrence rate of severe pregnancy complications among women with thrombophilia [8][9][10][11], as well as among women who were not tested for thrombophilias [12][13][14], and in women without thrombophilias [15]. Thrombophilias are associated with thrombosis, and there is a consensus that low molecular weight heparin (LMWH) reduces the incidence of recurrent thrombotic events.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Low molecular weight heparin versus no treatment in women with previous severe pregnancy complications and placental findings without thrombophilia

Kupferminc

Rimon

Many

et al. 2011

Blood Coagulation &Amp; Fibrinolysis

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Low molecular weight heparin (LMWH) treatment has been recommended for pregnant women with previous adverse pregnancy and who were diagnosed as having a thrombophilia. We now examined the effect of LMWH on pregnant women without thrombophilias who had severe pregnancy complications and placental vasculopathy in an earlier pregnancy. Seventy-two women with a history of severe preeclampsia, fetal growth restriction (FGR) less than fifth percentile, severe placental abruption and/or stillbirth after 20 weeks, whose thrombophilia workup was negative, were enrolled. Placental vasculopathy was defined as villous infarcts, fibrinoid necrosis of decidual vessels, fetal vessel thrombosis, evidence of placental abruption and perivillous fibrin deposition. The study group consisted of 32 pregnant women who were treated with LMWH and 40 pregnant women who were not treated with LMWH (control group) in their ensuing pregnancy in our institution between 2003 and 2007. The incidences of severe preeclampsia, FGR, placental abruption and stillbirth in the previous pregnancies were similar for both groups. The incidences of severe preeclampsia and placental abruption in the study group in the index pregnancy were significantly lower than the control group (3.13 versus 20%, P = 0.03; and 0 versus 15%, P = 0.03, respectively). The respective incidence of FGR was 6.25 versus 22.5%, and of overall adverse outcome was 9.4 versus 60% (P = 0.001). Treatment with LMWH may reduce the rate of the recurrence of severe pregnancy complications and significant placental vasculopathy in women without thrombophilias.

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“…Ein Eff ekt dieser Pr ä ventionsstragie ist bis zu einem Behandlungsbeginn ab sp ä testens der 16. kompletten SSW nachgewiesen [28] . Vor wenigen Wochen wurde eine kanadische Pilotstudie [29] ver ö ff entlicht, in der erstmals ein pr ä ventiver Eff ekt von niedermolekularem Heparinen (Dalteparin, Fragmin ® ) bei Risikoschwangeren nachgewiesen wurde. Frauen, die in einer vorherigen Schwangerschaft an einer schweren Pr ä eklampsie, einer fetalen Wachstumsrestriktion ( < 5.…”

Section: Prophylaktische Magnesiumtherapieunclassified

Empfehlungen zur Diagnostik und Behandlung der Präeklampsie im internationalen Vergleich: Was ist neu?

Seck

Fischer²

2009

Z Geburtshilfe Neonatol

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The new german guidelines for the treatment of hypertensive disorders in pregnancy have some important differentiations. The aim of the new guidelines is to avoid the early premature birth and to reduce the fetal and maternal morbidity and mortality. For the first time there ist the possibility and the recommendation for the prolongation of pregnancy. This means that the treatment of hypertensive disorders should start not before a blood pressure of >or=170/110 mmHg; thus the nutrition of the fetus will not be worsened and the worse perfusion of the placenta will be avoided. Further more the selection of antihypertensive treatment has changed: the first choice is not longer Dihydralazin (Nepresol) but Nifedipin (Adalat). In the treatment of HELLP-Syndrom there ist only one difference to the treatment of preeclampsia: the use of glucocorticosteroids. In the treatment of both hypertensive disorders in pregnancy there is the aim to finish the fetal lung mature induction before the delivery is planned or necessary. A new point of view in the german guidelines is the possibility of prediction and prevention of hypertensive disorders in pregnancy: patients who had already a hypertensive disorder in the pregnancy before or patients who have a pathologic flow in the Art. uterinae have a significant higher risk for a preeclampsia in this pregnancy. They should receive a preventive therapy with ASS. Because of these changes in the german guidelines the prolongation of pregnancy and the reduced rate of premature birth becomes more importance and helps to avoid a high rate of neonatal mortality and morbidity.

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Dalteparin for the Prevention of Recurrence of Placental-Mediated Complications of Pregnancy in Women Without Thrombophilia: A Pilot Randomized Controlled Trial

Cited by 38 publications

References 0 publications

Prevention of Preeclampsia and Intrauterine Growth Restriction With Aspirin Started in Early Pregnancy

Prevention of Preeclampsia and Intrauterine Growth Restriction With Aspirin Started in Early Pregnancy

Low molecular weight heparin versus no treatment in women with previous severe pregnancy complications and placental findings without thrombophilia

Empfehlungen zur Diagnostik und Behandlung der Präeklampsie im internationalen Vergleich: Was ist neu?

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