ROLE OF ANTI-THROMBOTIC THERAPY FOR RECURRENT PREGNANCY LOSS DUE TO ANTI-PHOSPHOLIPID SYNDROME
AbstractBackground: Recurrent pregnancy loss is a major health problem effecting 1‒2% of women ofreproductive age. Its causes range from chromosomal abnormalities to endocrinological factors andthrombophilia related factors. Treating thrombophilias especially antiphospholipid syndrome with lowdose aspirin and low molecular weight heparin improves foetal outcome. This study will add local datato already existing knowledge. Method: Sixty selected patients from gynaecology OPD of AeroHospital with clinical and/or serological findings of antiphospholipid syndrome from February 2009 toJanuary 2011 were given aspirin 75 mg once daily and enoxaparine 40 mg subcutaneously once dailyfrom 6–8 weeks to 35 and 37 weeks respectively. Results: Ninety-three percent of patients achievedlive birth. Out of these 75% patients delivered at term and 18% had preterm delivered. Four (7%) hadearly pregnancy loss and only one had early neonatal death due to extreme prematurity. None ofpatients experienced any major hemorrhagic complications. Conclusion: Use of low dose aspirin andlow molecular weight heparin is safe in pregnancy and improve foetal outcome in patients withrecurrent pregnancy loss due to antiphospholipids syndrome.Keywords: Recurrent pregnancy loss, Antiphospholipid syndrome, low molecular weight heparin
Clifford K, Rai R. Wason H, Regon L. An informative protocol
for the investigation of recurrent miscarriage, preliminary
experience of 500 consecutive cases. Human Reprod
Hatasake HH. Recurrent miscarriage:epidemiologic factors,
definitions and incidence. Clin Obstet Gynecol 1994;37:625–34.
Brenner B, Sarig Gy, Weiner Z, Younis J, Blumenfeld Z, Lanir
N. Thrombophilic polymorphisms are common in women with
fetal loss without apparent cause. Thromb Haemost 1999;82:6–9.
Triplett DA, Harris EN. Antiphopholipid Anti bodies and
reproduction. Am J Reprod Immunol1989;21:123–31.
Levine JS, Branch DW, Raich J. The antilospholipid syndrome N
Engl J Med 2002:346:752–63.
Roubey RAS. Immunology of Antiphospholipid syndrome.
Wilson W, Gharavi A, Koike T, Lockshin MD, Branch DW,
Piette JC, et al. International consenses statement on preliminary
classification criteria for definite antiphospholipid syndrome:
report on an international workshop. Arthritis Rheum
Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL,
Cervera R, et al. International Consenses statement on an update
of classification criteria for definite anti phospholipid syndromes
(APS). J Thromb Haemost 2006;4:295‒306.
Baker WF Jr, Bick RL. The clinical spectrum of
Antiphospholipid syndrome. Hematol Oncol Clin N Am
Hughes GR, Khamashta MA. Seronegative anti phospholipid
syndrome. Ann Rheum Dis 2003;62:1127.
Cervera R, Piette JC, Font J, Khamashta MA, Shoenfeld Y,
Camps MT, et al. Anti phospholipid syndrome: clinical and
immunologic manifestation and patterns of disease expression in
a chort of 1000 patients. Arthritis Rheum 2002;46:1019–27.
Mo D, Saravelos S, Metwally M, Makris M, Li TC. Treatment of
recurrent miscarriage and anti phospholipid syndrome with low
dose Enoxaparin and Aspirin. Reprod Biomed online
Berg TG. Antiphospholipid antibody syndrome and pregnancy.
Available from: http://emedicine.Medscape.Com/article/
J Ayub Med Coll Abbottabad 2010;22(3)
Ensom MH, Stephenson MD. Pharmaco kinetics of low
molecular weight Heparin and unfractionated Heparin in
pregnancy. J Soc Gynocol Investig 2004;11:377–83.
Stephenson MD, Ballem PJ, T sang P, Purkiss S, Houlihan E,
Enson MH. Treatment of Antiphospholipid antibody syndrome
(APS) in pregnancy: a random pilot total comparing low
molecular weight Heparin to unfractionated Heparin. J Obstet
Gynacol Can 2004;26:729–34.
Shannon M. Bates, Ian A. Grear, Jack Hirsh, Jerry S. Ginsberg
use of antithrombotic agents during pregnancy. Chest J
Brenner B, Hoffman R, Blumenfeld Z, Weiner Z, Younis JS.
Gestational outcome in Thrombophilic women with Recurrent
Pregnancy loss Treated by Enoxaparin. Thromb Haemost
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.