Department of Hematology, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel.
Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel.
Reprod Biomed Online. 2017 Oct;35(4):461-467. doi: 10.1016/j.rbmo.2017.06.018. Epub 2017 Jul 3.
We aimed to determine the outcome of threatened abortion in women treated with low-molecular weight heparin (LMWH) for recurrent pregnancy loss (RPL). Data of women with RPL who experienced threatened abortion while taking LMWH between 2007 and 2016 were retrospectively reviewed. All patients received the LMWH, enoxaparin (40 mg). Thrombophilia was present in 38 (33.3%) women, including 11 (9.6%) with antiphospholipid syndrome (APLS). The overall live birth rate was 58.8% (67/114). Live birth rates were 87.2% (41/47 patients) and 38.8% (26/67 patients) among those who discontinued versus those who continued LMWH treatment, respectively (P < 0.0001). Among APLS patients, live births resulted in eight of the nine women who continued LMWH. In multivariate analysis, discontinuation of LMWH was the only significant predictor of live birth outcome (P < 0.0001). Thrombophilia, presence of subchorionic haematoma, and severity of bleeding were not found to be associated with live birth outcomes. For women with threatened abortions, continuation of LMWH indicated to prevent RPL was negatively associated with live birth rates. Therefore, we support its discontinuation in this setting. Among women with APLS, LMWH continuation resulted in a relatively high live birth rate; we advocate against its withdrawal in this subset of patients.
我们旨在确定接受低分子量肝素（LMWH）治疗复发性妊娠丢失（RPL）的妇女发生威胁性流产的结局。回顾性分析了 2007 年至 2016 年间接受 LMWH 治疗时发生威胁性流产的 RPL 妇女的数据。所有患者均接受 LMWH，依诺肝素（40mg）治疗。38 例（33.3%）患者存在血栓形成倾向，包括 11 例（9.6%）抗磷脂综合征（APLS）患者。总的活产率为 58.8%（67/114）。停止与继续 LMWH 治疗的患者活产率分别为 87.2%（41/47 例）和 38.8%（26/67 例）（P<0.0001）。在 APLS 患者中，继续 LMWH 治疗的 9 例患者中有 8 例活产。多变量分析显示，停止 LMWH 是活产结局的唯一显著预测因素（P<0.0001）。血栓形成倾向、绒毛膜下血肿的存在以及出血的严重程度与活产结局无关。对于有威胁性流产的妇女，继续 LMWH 以预防 RPL 与活产率呈负相关。因此，我们支持在此情况下停止使用。在 APLS 患者中，继续使用 LMWH 治疗与相对较高的活产率相关；我们不建议在此类患者中停药。
