Anti-thrombotic treatment in recurrent pregnancy losses

Recurrent pregnancy loss is a common problem in women (1-5%). One of the leading causes is inherited thrombophilia. We enrolled 361 women (25-38 years-old) with history of at least two abortions due to unknown causes. We study the efficacy of three different antithrombotic treatments, comparing the Results in negative and positive thrombophilic patients. For congenital thrombophilia we studied inhibitors of coagulation (antithrombin, protein C, protein S), Factor V and Factor II (G20210A) mutations. Lupus Anticoagulant (KCT, DRRVVT), Anticardiolipin antibodies and homocysteinemia were considered for acquired thrombophilia. The screening identified 246 negative (68%) and 115 positive (32%). 167 women became pregnant, 80 (48%) negative and 87 (52%) positive. From eight weeks’ gestation they were submitted by three different therapy groups: Acetyl salicylic acid (ASA) 100mg/die until 3rd month of pregnancy; low molecular-weight heparin (LMWH) 40mg/die until 3rd month of pregnancy; ASA100mg plus LMWH 40mg/die until 3rd month of pregnancy. In the 80 negative patients, all three anti-thrombotic regimens were statistically significant effective respect previous untreated pregnancies: 69 live births (86%) versus 11 abortions (14%) (p0.0001) In the 87 patients positive, the treatment with and LMWH combined ASA was statistically significant effective respect to previous untreated pregnancies: 58 (67%) live birth versus 29 abortions (33%) (p0.001). Regimen with ASA alone did not shows any efficacy regarding pregnancy outcome. We suggest that thromboprophylaxis is indicated in women with previous pregnancy loss independently from alterations of thrombophilic factors.