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Editorials |5 May 2015

Is There Any Future for Low-Molecular-Weight Heparin in the Prevention of Pregnancy Loss?

Jean-Christophe Gris, MD, PhD

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Human reproduction is remarkably inefficient; nearly 70% of human conceptions do not survive to live birth. Recurrent pregnancy loss (RPL) is defined as recurrent loss of pregnancy before 24 weeks' gestation. Of couples trying to conceive, 5% will have 2 consecutive miscarriages and 1% will have 3. Implantation failure is the most frequent mechanism for early RPL (<10 weeks' gestation) and is multifactorial in origin. Evidence shows familial predisposition to spontaneous abortion in families in which RPL occurs (1), which suggests a genetic component (2). Some factors, such as fetal aneuploidy, are known to be causative; others, such as thrombophilia, only increase susceptibility to RPL. Recurrent pregnancy loss is heartbreaking for couples and frustrating for their clinicians. The ideal management remains undefined. The hypothesis that placental thrombogenesis may play a role in miscarriage, along with evidence suggesting that low-molecular-weight heparins (LMWHs) may improve trophoblast invasiveness through causes unrelated to their anticoagulant properties (3), led to testing LMWHs in women with RPL.
In this issue, Schleussner and colleagues (4) report new evidence on the effectiveness of LMWH in preventing RPL. They present results of a randomized, controlled, open-label, multicenter trial testing a daily injection of dalteparin–sodium, 5000 IU/d, plus vitamins versus multivitamins alone in German and Austrian women with at least 2 consecutive early miscarriages (<12 weeks' gestation) or 1 late miscarriage (≥12 weeks' gestation). Participants were enrolled at 5 to 8 weeks' gestation after a viable singleton pregnancy was confirmed by ultrasonography....
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Gris J. Is There Any Future for Low-Molecular-Weight Heparin in the Prevention of Pregnancy Loss?. Ann Intern Med. 2015;162:658–659. doi: 10.7326/M15-0564

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Published: Ann Intern Med. 2015;162(9):658-659.

DOI: 10.7326/M15-0564

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