Role of low dose ecosprin and heparin in achieving live births in pregnancy with thrombophilia


  • Shilpa Asthana Department of Obstetrics and Gynecology, INHS Asvini, Mumbai, Maharashtra, India
  • Bandana Sodhi Department of Obstetrics and Gynecology, Moolchand Medcity, Lajpat Nagar III, New Delhi, India
  • Satish Kumar Department of Pathology and Blood Tranfusion, Armed Forces Transfusion Centre, Delhi Cant., New Delhi, India



Adverse pregnancy outcome, Anti-phospholipid antibody syndrome, Thrombophilia – Inherited and Acquired, Maternal thrombophilia, Recurrent pregnancy loss, Thromboprophylaxis


Background: Thrombophilia is a disorder of haemostatic system that results in increased tendency of thrombus formation in both venous and arterial vascular system. The thrombotic events are not only restricted to venous thromboembolism but also can cause fetal loss (abortions or recurrent abortions and fetal demise), placental abruption, intrauterine growth restriction and severe pre-eclampsia. This study evaluates the role of administering thromboprophylaxis with heparin and ecosprin to patients with thrombophilia in pregnancy with previous history of adverse obstetric outcomes.

Methods: This prospective study was conducted in 60 patients diagnosed with thrombophilia during pregnancy. The objective of the study was to determine the role of administering low dose ecosprin and heparin as thromboprophylaxis in achieving live births in these patients with thrombophilia. All patients included in this study were prophylactically administered low dose ecosprin with either unfractionated heparin (5000 IU s.c, BD) or low molecular weight heparin (40 mg s.c, OD) during pregnancy. Patients were followed up in the antenatal period and the obstetric outcome noted. Comparisons were made between the obstetric outcomes of these patients receiving the aforesaid thromboprophylaxis with those of previous untreated pregnancies during which no ecosprin or heparin had been administered. The data obtained were subjected to statistical analysis using Students ‘t’ test and Chi square analysis. P value <0.05 was considered statistically significant.

Results: Fifty nine of the sixty patients with thrombophilia and previous adverse pregnancy outcome who received prophylaxis with ecosprin and heparin during the present pregnancy had live births (98.33%; p <0.0001). Fifty-eight (96.66%) of these patients progressed to term delivery and one (1.67%) pregnancy resulted in a pre-term birth.

Conclusions: Present study reveals that prophylaxis with low dose ecosprin and heparin administered to patients with thrombophilia (acquired or inherited) with history of previous adverse obstetric outcome resulted in a positive outcome in terms of a significantly higher number of live births. However, larger studies are needed to further elaborate on the role of thromboprophylaxis in pregnancies with inherited thrombophilia.


Alfirevic Z, Roberts D, Martlew V. How strong is the association between maternal thrombophilia and adverse pregnancy outcome. A systematic review. Eur J Obstet Gynecol Reprod Biol. 2002;101:6-14.

Rey E, Kahn SR, David M, Shrier I. Thrombophilic disorders and fetal loss: a meta-analysis. The Lancet. 2003 Mar 15;361(9361):901-8.

Kujovich JL. Thrombophilia and pregnancy complications. Am J Obstet Gynecol. 2004;191:412-24.

Robertson L, Wuo, Langhome P, Twaddle S, Clark P, Lowe GD et al. Thrombophilia in pregnancy: a systematic review. Br J Haematol. 2006;132 (2):171-96.

Middeldorp S. Thrombophilia and pregnancy complications: cause or association J Thromb Haemost. 2007; 5 Suppl 1:276-282.

Hossain N, Paidas MJ. Adverse pregnancy outcome, the uteroplacental interface, and preventive strategies, seminars in perinatology. Perintolol. 2007;31(4):208-12.

Vora S, Shetty S, Ghosh K. Thrombophilic dimension of recurrent fetal loss in Indian patients. Blood Coagul Fibrinolysis. 2008;19:581-4.

Pabinger I. Thrombophilia and its impact on pregnancy11Adapted from Pabinger I, Thrombophilia and its impact on pregnancy, Hamostaseologie. 2008;28(3):130-4.

Mishra MN, Bedi VS. Prevalence of common thrombophilia markers and risk factors in Indian patients with primary venous thrombosis. Sao Paulo Med J. 2010;128(5):263-7.

Hansda J, Roychowdhury J. Study of thrombophilia in recurrent pregnancy loss. J Obstet Gynecol India. 2012;62:536-40.

Bennett SA, Bagot CN, Arya R. Pregnancy loss and thrombophilia: the elusive link. Br J Hematol. 2012;157(5):529-42.

American College of Obstetricians and Gynecologists: Practice Bulletin No. 138: Inherited thrombophilias in pregnancy. Obstet Gynecol. 2013;122(3):706-17.

Simcox LE, Ormesher L, Tower C, Greer 1A. Thrombophilia and pregnancy complications. Int J Mol Sci. 2015;16(12):28418-28.

Kher A, Bauersachs R, Nielsen JD. The management of thrombosis in pregnancy: role of LMWH. Thromb Haemostat. 2007;97(4):505-13.

James A, Committee on Practice Bulletins—Obstetrics. Practice bulletin no. 123: thromboembolism in pregnancy. Obstet Gynecol. 2011 Sep;118(3):718-29.

Bates SM, Greer IA, Middledorp S, Veenstra DL, Prabulos AM, Vandvik PO. VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e691S-e736S.

Lockwood CJ. Thrombosis, thrombophilia and thromboembolism. American College of Obstetricians and Gynecologists; 2007.

Carp H, Dolitzky M, Inbal A. Thromboprophylaxis improves the live birth rate in women with consecutive recurrent miscarriages and hereditary thrombophilia. J Thromb Haemost. 2003;1:433-8.

Kupferminc MJ. Thrombophilia and pregnancy. Reprod Biol Endocrinol. 2003;1:111.

Brenner B. Antithrombotic prophylaxis for women with thrombophilia and pregnancy complications--Yes. J Thromb Haemost. 2003;1:2070-2.

Kupferminc MJ, Rimon E, Many A, Sharon M, Lessing JB, Gamzu R.. Low molecular weight heparin treatment during subsequent pregnancies of women with inherited thrombophilia and previous severe pregnancy complications. J Matern Fetal Neonatal Med. 2011;24:1042-5.

American College of Obstetricians and Gynecologists: Practice Bulletin No. 132: antiphospholipid syndrome. Obstet Gynecol. 2012;120(6):1514-21.

McNamee K, Dawood F, Farquharson R. Recurrent miscarriage and thrombophilia: an update. Curr Opin Obstet Gynecol. 2012;24:229-34.

Battinelli EM, Marshall A, Connors JM. The role of thrombophilia in pregnancy. Thrombosis. 2013 Dec 18;2013.

Lockwood CJ. Inherited thrombophilias in pregnant patients: detection and treatment paradigm 1, 2. Obstet Gynecol. 2002 Feb 28;99(2):333-41.

De Carolis S, Ferrazzani S, De Stefano V, Garofalo S, Fatigante G, Rossi E et al. Inherited thrombophilia: treatment during pregnancy. Fetal Diagnosis Therapy. 2006;21(3):281-6.

Folkeringa N, Brouwer JL, Korteweg FJ, Veeger NJ, Erwich JJ, Holm JP et al. Reduction of high fetal loss rate by anticoagulant treatment during pregnancy in antithrombin, protein C or protein S deficient women. Br J Haematol. 2007:1;136(4):656-61.






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