Reduction of high fetal loss rate by anticoagulant treatment during pregnancy in antithrombin, protein C or protein S deficient women

Abstract

Summary Hereditary thrombophilia is associated with an increased risk of fetal loss. Assuming that fetal loss is due to placental thrombosis, anticoagulant treatment might improve pregnancy outcome. In an observational family cohort study, we prospectively assessed the effects of anticoagulant drugs on fetal loss rates in women with hereditary deficiencies of antithrombin, protein C or protein S. The cohort contained 376 women (50 probands and 326 deficient or non‐deficient relatives). Probands were consecutive deficient patients with venous tromboembolism. Thromboprophylaxis during pregnancy was recommended in deficient women, irrespective of prior venous thromboembolism, and in non‐deficient women with prior venous thromboembolism. Outcome of first pregnancy was analysed in 55 eligible women. Of 37 deficient women, 26 (70%) received thromboprophylaxis during pregnancy, compared with three of 18 (17%) non‐deficient women. Fetal loss rates were 0% in deficient women with thromboprophylaxis versus 45% in deficient women without (P = 0·001) and 7% in non‐deficient women without thromboprophylaxis (P = 0·37). The adjusted relative risk of fetal loss in women who received thromboprophylaxis versus women who did not was 0·07 (95% confidence interval 0·001–0·7; P = 0·02). Our data suggest that anticoagulant treatment during pregnancy reduces the high fetal loss rate in women with hereditary deficiencies of antithrombin, protein C or protein S.

Inherited and Acquired Thrombophilia in Pregnancy

“…Another study demonstrated a fetal loss of between 28 to 32% in women with antithrombin III deficiency compared with 23 % in unaffected controls (Sanson et al, 1996). However no significant association between antithrombin deficiency and recurrent loss was found in other studies (Hatzis et al, 1999;Roque et al, 2004;Folkeringa et al, 2007). A Spanish retrospective study found 56% of women with antithrombin deficiency had an adverse pregnancy outcome (Robertson et al, 2006).…”

“…When comparing fetal loss rates in women without thromboprophylaxis, the presence was the highest with antithrombin deficiency (63%) followed by protein C deficiency (50%). The authors state that thromboprophylaxis reduces the fetal loss rate in women with such inherited thrombophilia by 15% (Folkeringa et al, 2007); however small numbers limits this study. It is of upmost importance to state that women were identified and recruited with reference to a large family cohort study and not due to previous recurrent miscarriage.…”

A descriptive evaluation of unfractionated heparin use during pregnancy

“…All patients anticoagulated for acute VTE in our study had a successful pregnancy. A recent report of thrombophilic patients receiving thromboprophylaxis during pregnancy found no fetal demise in women without a history of previous fetal demise [26].…”

Role of low dose ecosprin and heparin in achieving live births in pregnancy with thrombophilia

“…A few small uncontrolled trials or observational studies do favour antithrombotic therapy and ecosprin in pregnancies with inherited thrombophilia. 18,21,[25][26][27] However, the recommendation of antithrombotic therapy and ecosprin as a therapeutic option in pregnancy with inherited thrombophilia is still awaited for paucity of randomised control trials. In our study group, patients with either acquired or inherited thrombophilia had live births after treatment with heparin and ecosprin (live birth % -98.33%; p < 0.0001).…”