DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20200010

Comparative study of low dose aspirin versus combination of low dose aspirin and low molecular weight heparin in idiopathic recurrent pregnancy loss

S. Bhanu Rekha, K. Sharath Chandra

Abstract


Background: To compare the role of low dose aspirin versus combination of low dose aspirin and low molecular weight heparin in idiopathic recurrent pregnancy loss and assess the effectiveness of low dose aspirin and low molecular weight heparin in having a better obstetric outcome.

Methods: This study was conducted in a private hospital in Mahabubnagar from June 2017 to May 2019. A total of 80 pregnant ladies who had previous 2 and or more pregnancy losses in the early (before 20 weeks) or late (after 20 weeks) pregnancy period was included in the study. 80 pregnant women with idiopathic/unexplained recurrent pregnancy loss were properly evaluated in regard to the history of previous period of gestation of loss, previous scans in regard to documentation of fetal pole and gestation, cardiac activity, anomaly scan and growth scan and any special investigations in previous pregnancies and present pregnancy.

Results: A total 80 pregnant women with previous 2 and more unexplained pregnancy losses who were evaluated and found negative with major causes of pregnancy losses half of them (40) were treated with low dose aspirin alone and the other 40 women were treated with a combination of low dose aspirin (75 mg) and low molecular weight Heparin (20 mg) daily low molecular weight heparin till term. The aspirin alone group had 82.5% live birth rate and the combination group had 92.5% live birth rate which is quite satisfactory and more than the Aspirin alone group.

Conclusions: Use of combination of low dose aspirin and low molecular weight heparin seems to be a good choice of drugs in treating the unexplained recurrent pregnancy losses than low dose aspirin alone.


Keywords


Low dose aspirin, Low molecular weight heparin, Recurrent pregnancy loss

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References


Greer IA, Low molecular weight heparin for pregnancy complications. The Lancet. 2016;26:2570-2.

Yuksel H, Kayatas S, Boza AT, Api M, Ertekin AA, Cam C. Low molecular weight heparin use in unexplained recurrent miscarriage. Pak J Med Sci. 2014;30(6):1232-7.

Pasquier E, de Saint Martin L, Bohec C, Chauleur C, Bretelle F, Marhic G, Le Gal G, et al. Enoxaparin for prevention of unexplained recurrent miscarriage: a multicenter randomized double-blind placebo-controlled trial. Blood. 2015;125(14):2200-5.

Bose P, Black S, Kadyrov M, Weissenborn U, Neulen J, Regan L, et al. Heparin and aspirin attenuate placental apoptosis in vitro: implications for early pregnancy failure. Am J Obstet Gynecol. 2005;192(1):23-30.

Badawy AM, Khiary M, Sherif LS, Hassan M, Ragab A, Abdelall I. Low-molecular weight heparin in patients with recurrent early miscarriages of unknown aetiology. J Obstet Gynaecol. 2008;3:280-4.

Mak A, Cheung MW, Cheak AA, Ho RC. Combination of heparin and aspirin is superior to aspirin alone in enhancing live births in patients with recurrent pregnancy loss and positive anti-phospholipid antibodies: a meta-analysis of randomized controlled trials and meta-regression. Rheumatol. 2009;49(2):281-8.

Demers S, The use of aspirin durimg pregnancy. Am J obstet Gynecol. 2013;208(2):161-2.

Mitić G, Novakov Mikić A, Povazan L, Mitreski A, Kopitović V, Vejnović T. Thromboprophylaxis implementation during pregnancy in women with recurrent foetal losses and thrombophilia. Med Pregl. 2011;64:471-5.

Kaandorp SP, Goddijn M, van der Post JA, Hutten BA, Verhoeve HR, Hamulyák K, et al. Aspiri plus heparin or aspirin alone in women with recurrent miscarriage. N Engl J Med. 2010;362:1586-96.

Infante-Rivard C, David M, Gauthier R, Rivard GE. Lupus anticoagulants, anticardiolipin antibodies, and fetal loss a case-control study. N Engl J Med. 1999;325:1063-6.

Lockshin MD. Pregnancy loss in the antiphospholipid syndrome. Thromb Haemost. 1999;82:641-8.

Greer IA. Antithrombotic treatment for recurrent pregnancy loss?. J Thromb Haemost. 2011;9:302-5.

Kaandorp S, Di Nisio M, Goddijn M, Middeldorp S. Aspirin or anticoagulants for treating recurrent pregnancy loss in women without antiphospholipid syndrome. Cochrane Database Syst Rev. 2009;(1):CD004734.

Laude I, Rongières-Bertrand C, Boyer-Neumann C, Wolf M, Mairovitz V, Hugel B, et al. Circulating procoagulant microparticles in women with unexplained pregnancy loss: a new insight. Thromb Haemost. 2001;85:18-21.

McNamee K, Dawood F, Farquharson RG. Thrombophilia and early pregnancy loss. Best Pract Res Clin Obstet Gynaecol. 2012;26:91-102.