Publication:

Efficacy of anti-thrombotic treatment in thrombophilia patients with adverse pregnancy outcome

Background Thrombophilia is a potentially treatable cause of adverse pregnancy outcome. The objective was to compare the fetomaternal outcome in thrombophilia patients with adverse pregnancy outcome after treating with low-molecular-weight (LMW)/ unfractionated heparin and aspirin.

Methods 54 antenatal women studied who had an earlier or presenting pregnancy complicated by adverse pregnancy outcome were included in this study. In the present pregnancy, therapy consisting of LMW heparin and aspirin was administered who were found to be thrombophilia positive. Patients also received folic acid supplementation throughout their pregnancy. The fetomaternal outcome is compared according to the time of initiation of treatment.

Results Low-molecular-weight heparin and aspirin was well tolerated and none of the women or the newborns developed any hemorrhagic complications.3 thrombophilia negative cases with history of recurrent pregnancy loss aborted even getting treatment from 1 trimester. 1 thrombophilia positive case with history of recurrent pregnancy loss aborted when received treatment from 2nd trimester. There is 25.8% increase in birth weight of neonate if thrombophilia positive cases were treated from 1st trimester. Whereas there was only 10.23% increase in birth weight in thrombophilia negative cases when treated from first trimester. We found, our treatment was significantly effective in preventing IUD, IUGR, abruption, abortion, eclampsia. Though prevention of PIH had no significant correlation with antithrombotic treatment, only 2 cases booked from 1st trimester developed PIH among thrombophilia positive cases. But neither of cases had suffered from any severe complication as compared to 81% of eclampsia cases, 16.67% of DVT cases, 1 case of mortality in cases treated after third trimester.

Conclusions This case control trial suggests that patients with adverse pregnancy outcome and thrombophilia may get benefit from treatment with combined LMW heparin and aspirin in subsequent pregnancies. We suggest all patients with adverse pregnancy outcome should be investigated for thrombophilia markers.