Low dose unfractionated heparin with low dose aspirin in treatment of thrombo prophylaxis in utero placental insufficiency: a new vision in heparinization during pregnancy
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20184927Keywords:
Aspirin, Heparin, IUGR (Intrauterine Growth Retardation), LMWH, LDA (Low dose Aspirin), Pregnancy induced hypertension (PIH), Unfractionated Heparin (UFH)Abstract
Background: The use of heparin and aspirin in obstetric care has grown considerably since their introduction into clinical practice. Because of the physiological changes of pregnancy, the usage of heparin and optimal dosage of heparin remains uncertain. Here our institute designed low dose Unfractionated Heparin (5000 IU s/c daily) as thrombo Prophylaxis regimen. To study the outcome of low dose UFH (5000 IU sc /daily) + Low dose aspirin (75 mg oral per day) for thrombo prophylaxis in utero placental insufficiency, in patient with 2 or more abortions.
Methods: This retrospective study was conducted in 135 patients with 2 or more abortions as obstetric history. Prophylactic low dose of UFH (5000 IU s/c daily) + LDA 75 mg oral was initiated. The Primary outcome is live birth, and secondary outcomes is Reduced incidence of early onset of gestational hypertension (HT), Intrauterine Growth Retardation (IUGR).
Results: Out of 135 women 131 gave live birth, 2 had first trimester abortion and 2 had intrauterine death by 5 to 6 months. PIH was higher in patients with more than 30 years of age.
Conclusions: In our Retrospective, data combination of low dose UFH (5000IU s/c) + LDA (75mg oral) is as safe as routine thrombo prophylaxis with good compliance.
References
Heuser, C., and Ware Branch, D. (n.d.). Disorders of Coagulation in Pregnancy. In D. James, P. Steer, C. Weiner, B. Gonik, and S. Robson (Eds.), Cambridge: Cambridge University Press. High-Risk Pregnancy: Management Options pp. 1085-1107.
Noble LS, Kutteh WH, Lashley N, Franklin RD, Herrada J. Antiphospholipid antibodies (APA) associated with recurrent pregnancy loss: prospective, multicenter, controlled pilot study comparing treatment with enoxaparin versus unfractionated heparin. Fertil Steril.2005;83(3):684-90.
Stephenson M, Ballem P, Tsang P, Purkiss S, Ensworth S, Houlihan E et al. Treatment of Antiphospholipid Antibody Syndrome (APS) in Pregnancy: A Randomized Pilot Trial Comparing Low Molecular Weight Heparin to Unfractionated Heparin. J Obstet Gynaecol Canada. 2004;26(8):729-34.
Patel JP, Hunt BJ. Where do we go now with low molecular weight heparin use in obstetric care? J Thromb Haemost. 2008;6(9):1461-7.
Smith MP, Norris LA, Steer PJ, Savidge GF, Bonnar J. Tinzaparin sodium for thrombosis treatment and prevention during pregnancy. Am J Obstet Gynecol. 2004;190(2):495-501.
IanA.Greer and Catherine Nelson Piercy. Low – Molecular Weight Heparin FOR Thrombo Prophylaxis and Treatment of Venous Thrombo Embolism in Pregnancy. Blood. 2005;106(2):401-7.
James D, Steer P, Weiner C Gonik B. High risk pregnancy. Philadelphia, PA: 4th Saunders/Elsevier; 2011.
Queenan J, Spong C, Lockwood C. Queenan's management of high-risk pregnancy. Chichester, West Sussex: Wiley-Blackwell; 2012.
Williams J. Obstetrics. Stamford, Conn.: Appleton and Lange; 1997.
Regan L, Rai R. Epidemiology and the medical causes of miscarriage. Best practice and research Clinic Obstet Gynaecol. 2000;14(5):839-54.
Rai R, Regan L. Recurrent miscarriage. The Lancet. 2006;368(9535):601-11.
van Hoorn ME, Hague WM, van Pampus MG, Bezemer D, de Vries JI. Low-molecular-weight heparin and aspirin in the prevention of recurrent early-onset pre-eclampsia in women with antiphospholipid antibodies: the FRUIT-RCT. European J Obstet Gynecol Reproduct Biol. 2016;197:168-73.
Dresang LT, Fontaine P, Leeman L, King VJ. Venous thromboembolism during pregnancy. Am Fam Physician. 2008;77(12).
Steinberg ZL, Dominguez-Islas CP, Otto CM, Stout KK, Krieger EV. Maternal and Fetal Outcomes of Anticoagulation in Pregnant Women with Mechanical Heart Valves. J Am Coll Cardiol. 2017;69(22):2681-91.
Salmon J, Girardi G, Lockshin M. The antiphospholipid syndrome as a disorder initiated by inflammation: implications for the therapy of pregnant patients. Nature Clinical Practice Rheumatol. 2007;3(3):140-7.
Backos M, Rai R, Thomas E, Murphy M, Doré C, Regan L. Bone density changes in pregnant women treated with heparin: a prospective, longitudinal study. Human Reproduct. 1999;14(11):2876-80.
