Brenner B, Hoffman R, Blumenfeld Z, Weiner Z, Younis J S
Thrombosis and Hemostasis Unit, Rambam Medical Center and Bruce Rappaport Faculty of Medicine, Haifa, Israel.
Thromb Haemost. 2000 May;83(5):693-7.
Inherited and acquired thrombophilia are associated with recurrent pregnancy loss (RPL). We have evaluated the efficacy and safety of the low molecular weight heparin enoxaparin in 50 women, (mean age 26 +/- 3 years) with RPL (> or =3 losses in 1st, > or =2 losses in 2nd and > or =1 loss in 3rd trimester) who were found to harbor thrombophilia. Twenty-seven had a solitary thrombophilic defect, and twenty-three women had combined thrombophilic defects: 17--two defects and 6--three defects. Following diagnosis of thrombophilia, sixty-one subsequent pregnancies were treated with the low molecular weight heparin enoxaparin throughout gestation until 4 weeks after delivery. Dosage was 40 mg/day in women with solitary defect and 80 mg/day in combined defects. Aspirin, 75 mg daily was given in addition to enoxaparin to women with antiphospholipid syndrome. Forty-six out of 61 (75%) gestations treated by enoxaparin resulted in live birth compared to only 38/193 (20%) of the untreated pregnancies in these 50 women prior to diagnosis of thrombophilia (p <0.00001). In 23 women without a single living child following 82 untreated gestations, antithrombotic therapy resulted in 26/31 (84%) successful deliveries (p <0.0001). In 20 women with a prior living child, antithrombotic therapy improved successful delivery from 33/86 (38%) to 20/21 (95%) (p <0.0001). Enoxaparin dose of 40 mg/day resulted in live birth in 24/35 (69%) of gestations, compared to 19/23 (83%) gestations in women treated with 80 mg/day (p = 0.37). Only one thrombotic episode and one mild-bleeding episode were noticed during enoxaparin therapy. Enoxaparin is safe and effective in prevention of pregnancy loss in women with inherited and acquired thrombophilia.
遗传性和获得性血栓形成倾向与复发性流产（RPL）相关。我们评估了低分子量肝素依诺肝素对50名患有血栓形成倾向的复发性流产女性（平均年龄26±3岁，孕早期流产≥3次，孕中期流产≥2次，孕晚期流产≥1次）的疗效和安全性。27名女性存在单一血栓形成缺陷，23名女性存在复合血栓形成缺陷：17名有两种缺陷，6名有三种缺陷。诊断为血栓形成倾向后，61次后续妊娠在整个妊娠期直至分娩后4周均接受低分子量肝素依诺肝素治疗。单一缺陷女性的剂量为40mg/天，复合缺陷女性的剂量为80mg/天。对于抗磷脂综合征女性，除依诺肝素外，每天加用75mg阿司匹林。依诺肝素治疗的61次妊娠中有46次（75%）活产，而在这50名女性诊断血栓形成倾向之前，未治疗的193次妊娠中只有38次（20%）活产（p<0.00001）。在82次未治疗妊娠后没有一个存活子女的23名女性中，抗血栓治疗导致26/31次（84%）分娩成功（p<0.0001）。在有过存活子女的20名女性中，抗血栓治疗使成功分娩率从33/86（38%）提高到20/21（95%）（p<0.0001）。40mg/天依诺肝素剂量组的35次妊娠中有24次（69%）活产，而80mg/天治疗组女性的23次妊娠中有19次（83%）活产（p=0.37）。依诺肝素治疗期间仅观察到1次血栓事件和1次轻度出血事件。依诺肝素在预防遗传性和获得性血栓形成倾向女性的妊娠丢失方面安全有效。
