USE OF A LOW-MOLECULAR-WEIGHT HEPARIN (ENOXAPARIN) OR OF A PHENFORMIN-LIKE SUBSTANCE (MOROXYDINE CHLORIDE) IN PRIMARY EARLY RECURRENT ABORTERS WITH AN IMPAIRED FIBRINOLYTIC CAPACITY

An impaired fibrinolytic capacity, defined as an insufficient venous o cclusion-induced shortening of the plasma euglobulin clot lysis time, is a common feature in women suffering from primary early recurrent un explained miscarriages (1,2). We investigated the therapeutic effect o f a low-molecular-weight heparin and of a phenformin-like substance. I n a prospective, randomized trial, 30 consecutive patients initially r eceived either enoxaparin, 20 mg per day during one month, or moroxydi ne chloride, 1200 mg per day during one month. In case of fibrinolytic status normalization, they were treated during 6 months by the benefi cial treatment which was planned to be continued during eventual pregn ancies. Patients with hypofibrinolysis persistence received the altern ative treatment during another month and a new evaluation was performe d. No treatment was given when a persistent abnormal response to the v enous occlusion test was evidenced. In case of positive response, the treatment was continued during 6 months. The primary study end-points consisted of any of the following: effect of the treatments on the fib rinolytic response; number of patients becoming pregnant during the 6 months following the last venous occlusion test; number of full-term p regnancies. Concerning the effects on the fibrinolytic system, 20 out of 29 women responded to the first or second-line enoxaparin treatment whereas only 1 woman out of 19 responded to moroxydine chloride (p=0. 00002). Concerning the effects on fertility, responders to LMWH were m ore likely to initiate a new pregnancy than non-responders (16/20 vs 2 /10, p=0.002). In patients conceiving, LMWH responders were more likel y to obtain live births than nonresponders (13/16 vs. 0/2, p=0.02). Th e 9 women who had not responded to both treatments and the one who had responded to moroxydine chloride are still childless. Thirteen of the 20 previously childless women who had responded to enoxaparin had a s uccessful pregnancy whilst taking the low-molecular weight heparin (p= 0.0009). The low-molecular weight heparin enoxaparin was associated wi th successful pregnancies in patients with recurrent unexplained misca r riages associated with an impaired fibrinolytic capacity.