Treatment with enoxaparin adapted to the fertility program in women with early recurrent pregnancy loss and thrombophilia.

Acquired and inherited thrombophilia are associated with recurrent pregnanc y loss (RPL). Antithrombotic therapy could restore hemostatic balance and i mprove early placentation and gestational outcome. We evaluated the efficac y of enoxaparin adapted to the fertility program for prevention of pregnanc y loss in 35 women (W) with early RPL and thrombophilia. Previous to the di agnosis of thrombophilla, they had had a total of 105 gestations of which 8 9 (85%) ended in early pregnancy loss. After diagnosis of thrombophilia, 35 subsequent pregnancies were treated with enoxaparin. In 5 cases assisted r eproductive techniques were necessary to achieve pregnancy due to couple in fertility. In 17 W who had had at least one preclinical pregnancy loss, eno xaparin (20 mg/d/sc) was started previous to conception and adapted to the fertility program. All the women continued with the gestational regime. Eig hteen W with only clinical pregnancy loss started enoxaparin (20 mg twice p er day sc) after biochemical pregnancy diagnosis. During gestations heparin dose was adjusted with anti Xa test, maintaining a range between 0.3 at 0. 6 u/ml. With antithrombotic therapy, 30/35 (85%) of the pregnancies ended i n live birth versus 16/105 (15%) of the pregnancies without treatment (p < 0.001). These results suggest that enoxaparin adapted to the fertility prog ram can be effective in the prevention of preclinical and clinical abortion in women with thrombophilia.