Mutlu Ilknur, Mutlu Mehmet Firat, Biri Aydan, Bulut Berk, Erdem Mehmet, Erdem Ahmet
aDepartment of Obstetrics & Gynecology, Gazi University Faculty of Medicine, Ankara bDepartment of Obstetrics & Gynecology, HRS Women Hospital, Ankara cDepartment of Obstetrics & Gynecology, Okmeydani Research and Training Hospital, Istanbul, Turkey.
Blood Coagul Fibrinolysis. 2015 Apr;26(3):267-73. doi: 10.1097/MBC.0000000000000219.
This study investigates the effects of anticoagulant therapy on pregnancy outcomes in 204 patients with thrombophilia and previous poor obstetric outcomes. Patients with poor obstetric history (pre-eclampsia, intrauterine growth retardation, fetal death, placental abruption, recurrent pregnancy loss) and having hereditary thrombophilia were included in this study. Poor obstetric outcomes were observed more frequently in patients who had not taken anticogulant therapy compared with treated group. Live birth rate, gestational age at birth and Apgar scores were significantly higher in the treated group when compared with the untreated group. There were no significant differences in terms of birthweight, mode of delivery and admission rates to the neonatal intensive care unit (NICU). Low-molecular-weight heparin (LMWH) plus acetylsalicylic acid (ASA) had higher gestational age at birth, Apgar scores, live birth rate and a lower abortion rates when compared with controls; in contrast, no significant difference was observed in terms of birthweight, mode of delivery, obstetric complications and admission rates to NICU. There were no significant differences between control group and both LMWH only and ASA only groups in terms of gestational age at birth, Apgar scores, birthweight, mode of delivery, obstetric complications and admission rates to NICU. Only LMWH group had higher live birth rate as compared with control group. The use of only ASA did not seem to affect the perinatal complication rates and outcomes. In conclusion, anticoagulant therapy with both LMWH and ASA seems to provide better obstetric outcomes in pregnant women with thrombophilia and previous poor obstetric outcomes.
本研究调查了抗凝治疗对204例患有易栓症且既往产科结局不良的患者妊娠结局的影响。本研究纳入了有不良产科病史(子痫前期、胎儿生长受限、胎儿死亡、胎盘早剥、复发性流产)且患有遗传性易栓症的患者。与治疗组相比,未接受抗凝治疗的患者不良产科结局更为常见。与未治疗组相比,治疗组的活产率、出生时的孕周和阿氏评分显著更高。出生体重、分娩方式和新生儿重症监护病房(NICU)收治率方面无显著差异。与对照组相比,低分子量肝素(LMWH)加乙酰水杨酸(ASA)组出生时孕周、阿氏评分、活产率更高,流产率更低;相比之下,出生体重、分娩方式、产科并发症和NICU收治率方面未观察到显著差异。对照组与仅使用LMWH组和仅使用ASA组在出生时孕周、阿氏评分、出生体重、分娩方式、产科并发症和NICU收治率方面无显著差异。与对照组相比,仅LMWH组活产率更高。仅使用ASA似乎不影响围产期并发症发生率和结局。总之,LMWH和ASA联合抗凝治疗似乎能为患有易栓症且既往产科结局不良的孕妇提供更好的产科结局。