Low-molecular-weight heparin for the prevention of obstetric complicationsin women with thrombophilias

Objective. To evaluate the benefit of combined low-molecular-weight (LMW) h eparin and aspirin for prophylaxis in women carriers of thrombophilia who h ad previously suffered from severe obstetric complications. Methods. The 33 studied women had an earlier pregnancy complicated by sever e preeclampsia. abruptio placentae, intrauterine growth retardation, or int rauterine fetal death. All were subsequently diagnosed as carrying inherite d thrombophilias. In their subsequent pregnancy, prophylactic therapy consi sting of LMW heparin 40 mg/day (Enoxaparin, Rhone-Poulenc-Rorer, France) an d aspirin was administered. Patients who were found to be homozygotes for t he methylenetetrahydrofolate reductase mutation also received folic acid su pplementation throughout their pregnancy. Results. Low-molecular-weight heparin was well tolerated and none of the wo men or the newborns developed any hemorrhagic complications. Only three (9. 1%) of the women developed pregnancy complications. The mean gestational ag e and the mean birth weight at delivery in the previously complicated pregn ancies were 32.1 +/- 5.0 weeks and 1175 +/-. 590 g, respectively, compared to 37.6 +/- 2.3 weeks and 2719 +/- 526 g, respectively, in the treated preg nancies (p < 0.001). Conclusions. This uncontrolled trial suggests that patients with obstetric complications and an inherited thrombophilia may benefit from treatment wit h combined LMW heparin and aspirin in subsequent pregnancies. However, this needs to be verified by controlled trials before considering clinical appl ication.