Is There Any Future for Low-Molecular-Weight Heparin in the Prevention of Pregnancy Loss?
Authors: Jean-Christophe Gris
Journal: Annals of Internal Medicine (2015)

Editorials5 May 2015Is There Any Future for Low-Molecular-Weight Heparin in the Prevention of Pregnancy Loss?Jean-Christophe Gris, MD, PhDJean-Christophe Gris, MD, PhDFrom University Hospital, Nîmes, Nîmes, France.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-0564 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail 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, ...References1. Christiansen OB, Mathiesen O, Lauritsen JG, Grunnet N. Idiopathic recurrent spontaneous abortion. Evidence of a familial predisposition. Acta Obstet Gynecol Scand. 1990;69:597-601. [PMID: 2094140] CrossrefMedlineGoogle Scholar2. Kolte AM, Nielsen HS, Moltke I, Degn B, Pedersen B, Sunde L, et al. A genome-wide scan in affected sibling pairs with idiopathic recurrent miscarriage suggests genetic linkage. Mol Hum Reprod. 2011;17:379-85. [PMID: 21257601] doi:10.1093/molehr/gar003 CrossrefMedlineGoogle Scholar3. D'Ippolito S, DiNicuolo F, Marana R, Castellani R, Stinson J, Tersigni C, et al. Emerging nonanticoagulant role of low molecular weight heparins on extravillous trophoblast functions and on heparin binding-epidermal growth factor and cystein-rich angiogenic inducer 61 expression. Fertil Steril. 2012;98:1028-36. [PMID: 22818289] doi:10.1016/j.fertnstert.2012.06.042 CrossrefMedlineGoogle Scholar4. Schleussner E, Kamin G, Seliger G, Rogenhofer N, Ebner S, Toth B, et al; ETHIG II group. Low-molecular-weight heparin for women with unexplained recurrent pregnancy loss. A multicenter trial with a minimization randomization scheme. Ann Intern Med. 2015;162:601-9. doi:10.7326/M14-2062 LinkGoogle Scholar5. Clark P, Walker ID, Langhorne P, Crichton L, Thomson A, Greaves M, et al; Scottish Pregnancy Intervention Study (SPIN) collaborators. SPIN (Scottish Pregnancy Intervention) study: a multicenter, randomized controlled trial of low-molecular-weight heparin and low-dose aspirin in women with recurrent miscarriage. Blood. 2010;115:4162-7. [PMID: 20237316] doi:10.1182/blood-2010-01-267252 CrossrefMedlineGoogle Scholar6. Kaandorp SP, Goddijn M, van der Post JA, Hutten BA, Verhoeve HR, Hamulyák K, et al. Aspirin plus heparin or aspirin alone in women with recurrent miscarriage. N Engl J Med. 2010;362:1586-96. [PMID: 20335572] doi:10.1056/NEJMoa1000641 CrossrefMedlineGoogle Scholar7. Visser J, Ulander VM, Helmerhorst FM, Lampinen K, Morin-Papunen L, Bloemenkamp KW, et al. Thromboprophylaxis for recurrent miscarriage in women with or without thrombophilia. HABENOX: a randomised multicentre trial. Thromb Haemost. 2011;105:295-301. [PMID: 21103659] doi:10.1160/TH10-05-0334 CrossrefMedlineGoogle Scholar8. Suzumori N, Sugiura-Ogasawara M. Genetic factors as a cause of miscarriage. Curr Med Chem. 2010;17:3431-7. [PMID: 20712563] CrossrefMedlineGoogle Scholar9. Bouvier S, Cochery-Nouvellon E, Lavigne-Lissalde G, Mercier E, Fabbro-Peray P, Balducchi JP, et al. Comparative incidence of pregnancy outcomes in thrombophilia-positive women from the NOH-APS observational study. Blood. 2014;123:414-21. [PMID: 24200686] doi:10.1182/blood-2013-09-525014 CrossrefMedlineGoogle Scholar10. Greer IA, Brenner B, Gris JC. Antithrombotic treatment for pregnancy complications: which path for the journey to precision medicine? Br J Haematol. 2014;165:585-99. [PMID: 24593333] doi:10.1111/bjh.12813 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University Hospital, Nîmes, Nîmes, France.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-0564.Corresponding Author: Jean-Christophe Gris, MD, PhD, Département d'Hématologie, Centre Hospitalier Universitaire, Groupe Hospitalo-Universitaire Carémeau, Place du Professeur Robert Debré, 30029 Nîmes Cedex 9, France; e-mail, jean.christophe.[email protected]fr. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoLow-Molecular-Weight Heparin for Women With Unexplained Recurrent Pregnancy Loss Ekkehard Schleussner , Gabriele Kamin , Gregor Seliger , Nina Rogenhofer , Susanne Ebner , Bettina Toth , Michael Schenk , Melanie Henes , Michael K. Bohlmann , Thorsten Fischer , Oana Brosteanu , Rupert Bauersachs , David Petroff , and Low-Molecular-Weight Heparin for Women With Unexplained Recurrent Pregnancy Loss Ekkehard Schleussner , Gabriele Kamin , Gregor Seliger , Nina Rogenhofer , Susanne Ebner , Bettina Toth , Michael Schenk , Melanie Henes , Michael K. Bohlmann , Thorsten Fischer , Oana Brosteanu , Rupert Bauersachs , David Petroff , and Metrics Cited byLMWH in IVF – Biomarkers and benefits 5 May 2015Volume 162, Issue 9Page: 658-659KeywordsAneuploidyAspirinBirthDisclosureForecastingKaryotypesLow molecular weight heparinMiscarriageMutationPregnancy ePublished: 5 May 2015 Issue Published: 5 May 2015 Copyright & PermissionsCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...