Enoxaparin and aspirin therapy for recurrent pregnancy loss due to anti-phospholipid syndrome (APS)
Open accessAbstract
Recurrent miscarriage affects 1–2% of women. Thrombophilia included antiphospholipid syndrome has been identified in about 50% of women with recurrent miscarriage. Aspirin and heparin therapy is frequently prescribed for APS, yet there is no robust evidence for the most efficacious regime. To determine maternal and foetal outcomes in women with APS managed with aspirin or enoxaparin plus aspirin during pregnancy. Prospective non randomized study. High-risk pregnancy unit-Benha University Hospital. Seventy selected patients during pregnancy with clinical and/or serological findings of antiphospholipid syndrome were divided into two Groups: Group A (n = 47) had received aspirin (81 mg once daily orally) plus LMWH enoxaparin (40 mg subcutaneously/day) while Group B (n = 23) had received low-dose aspirin (81 mg day orally). Maternal outcomes included thromboembolic, haemorrhagic complications and pregnancy-induced hypertension. Prematurity, intrauterine growth restriction and neonatal death were considered as foetal complications. There were significant differences between Groups A and B in the rate of miscarriages (4 in Group A (9%) versus 8 in Group B (35%); p = 0.02), number of live births (43/47(91%) versus 15/23(65%); p = 0.02), mean gestational age (37.86 ± 1.8 versus 36.13 ± 2.39 weeks; p = 0.005), neonatal birth weight (3252 ± 459 versus 2907 ± 618 g; p = 0.03) and rate of pre-eclampsia (3/43 (7%) versus 6/15 (40%); p = 0.009). Although not statistically significant, women in Group A tended to have lower rates of preterm births (6/43 (14%) versus 3/15 (20%); p = 0.89) and IUGR (5/43 (12%) versus 5/15 (33%); p = 0.13) than in Group B. Use of low dose aspirin and enoxaparin 40 mg subcutaneously daily in patients with RPL due to antiphospholipid syndrome resulted in higher live birth rates compared to low dose aspirin alone. Solid conclusions from this study are limited due to the small number of patients, non-randomization of groups and discrepancy in number between groups because the choice of the interventional drug was left to patient’s preference after counselling. A larger RCT is needed.
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In women with a history of fetal loss, LDA plus heparin was associated with higher likelihood of live birth than LDA alone.
“For women with a history of fetal loss, combination treatment with LDA and heparin was associated with a higher likelihood of live birth compared with treatment with LDA alone.”
From EULAR recommendations for the management of antiphospholipid syndrome in adults (2019) · cites this paper as [51]
The Results (section 3; page not provided) report more live births with low-dose aspirin plus LMWH than with aspirin alone (91% versus 65%; p = 0.02). However, the study included women with antiphospholipid syndrome and recurrent pregnancy loss; it does not establish the comparison for women with a history of fetal loss generally. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe studies on fetal loss included women with histories of both early and mid-pregnancy losses.
“However, these studies included women with histories of both early and mid-pregnancy losses.48–52”
From EULAR recommendations for the management of antiphospholipid syndrome in adults (2019) · cites this paper as [51]
Pooled data from one RCT in women with first-trimester losses and eight observational studies not exclusively early losses indicated higher likelihood of live births with LDA plus prophylactic heparin versus LDA alone.
“Pooled data from one RCT including only patients with a history of first trimester losses46 and eight supporting observational studies47–54 that did not exclusively study women with early pregnancy losses indicated a higher likelihood of live births with combination treatment with LDA and heparin at prophylactic dosage versus LDA alone.”
From EULAR recommendations for the management of antiphospholipid syndrome in adults (2019) · cites this paper as [51]
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References 29 · Cited by 20
Research works printed but not linked: 3
- Hughes GR, Khamashta MA. Seronegative anti phospholipid syndrome. Ann Rheum Dis 2003;62:1127.
- Levine JS, Branch DW, Rauch J. The antiphospholipid syn- drome. N Engl J Med 2002;46(10):752-63.
- Royal College of Obstetrician and Gynaecologists. The investi- gation and treatment of recurrent miscarriage (internet), Guide- line No 17. London: RCOG Press, 2003 May (cited 2009 Feb 8). p. 13.
- Authors
- Mohamed, K. A. A., & Saad, A. S.
- Affiliations
- Benha University (EG)
- Corresponding author
- Mohamed, Khalid Abd Aziz
- Venue
- Middle East Fertility Society Journal
- Published
- 2014-09
- Volume
- 19
- Issue
- 3
- Pages
- 176-182
- ISSN
- 1110-5690 (ISSN-L)
- OpenAlex
- W2018673095
- Cited by
- 20
- References
- 29
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 1 · 2022: 2 · 2021: 4 · 2020: 2 · 2019: 5 · 2018: 2 · 2017: 1 · 2016: 1
- FWCI
- 0.55
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- Locations
- Middle East Fertility Society Journal (publishedVersion, cc-by-nc-nd)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Life Sciences › Immunology and Microbiology › Immunology › Reproductive System and Pregnancy
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Keywords
- recurrent pregnancy loss, enoxaparin, low-dose aspirin, low molecular weight heparin, thromboprophylaxis, miscarriage prevention, preeclampsia, preterm birth, fetal growth restriction, birth weight, maternal outcomes, fetal outcomes, gestational hypertension, thrombophilia
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