LOW-MOLECULAR-WEIGHT HEPARIN COMBINED WITH ASPIRIN IN PREGNANT-WOMEN WITH THROMBOPHILIA AND A HISTORY OF PREECLAMPSIA OR FETAL GROWTH RESTRICTION - A PRELIMINARY-STUDY

Objective: To assess the prevalence of haemostatic abnormalities in pa tients with an obstetric history of preeclampsia and/or fetal growth r estriction and documented thrombophilia, and to evaluate the effects o f low-molecular-weight heparin (LMWH) and aspirin on pregnancy outcome . Method: A total of 276 patients with a history of preeclampsia and/o r fetal growth restriction were tested for the presence of coagulation abnormalities and anticardiolipin antibodies (ACA). Ninety patients w ith preeclampsia and 15 patients with isolated fetal growth restrictio n had haemostatic abnormalities. Twenty-six patients with coagulation abnormalities: protein S-deficiency, activated protein C (APC) resista nce and/or greater than or equal to 15 ACA GPL and/or MPL had a subseq uent pregnancy and were treated with aspirin in combination with LMWH. Their pregnancy outcome was compared with all patients having a subse quent pregnancy from the same cohort without abnormalities, or <15 ACA GPL and/or MPL who received aspirin (n=19). Results: In subsequent pr egnancies birth weight of babies born to patients with an unequivocal coagulation abnormality (i.e., protein S-deficiency, APC resistance, o r ACA titres greater than or equal to 15 GPL and/or MPL), were higher than in the group with no disorders or <15 ACA GPL and/or MPL (P=0.019 ). Conclusions: In this preliminary study, LMWH appears to have a favo urable effect on the pregnancy outcome of women with a history of pree clampsia and/or fetal growth restriction and documented thrombophilia. Randomised trials are required. (C) 1998 Elsevier Science Ireland Ltd .