Key result
ASA plus LMWH is not associated with fewer composite adverse pregnancy outcomes than ASA alone.
Why the study?
The risk of recurrence of severe placenta-mediated pregnancy complications and the efficacy of different anti-thrombotic regimens in women with late fetal loss without thrombophilia were unclear.
Does ASA plus LMWH reduce the risk of placenta-mediated pregnancy complications in women with a history of late fetal loss and placental infarction without thrombophilia compared to ASA alone?
Observational (n=128)
Does ASA plus LMWH reduce the risk of placenta-mediated pregnancy complications in women with a history of late fetal loss and placental infarction without thrombophilia compared to ASA alone?
In women with prior late fetal loss and placental infarction without thrombophilia, adding LMWH to ASA prophylaxis reduces the risk of delivery <34 weeks but does not significantly improve composite placenta-mediated outcomes.
Answers are grounded in this paper and cite their sources.
May reduce delivery <34 weeks without improving composite outcomes; leaves open LMWH benefit in randomized trials of this population.
Purpose To evaluate the risk of recurrence of severe placenta-mediated pregnancy complications and compare the efficacy of two different anti-thrombotic regimens in women with a history of late fetal loss without thrombophilia.Patients and methods We performed a 10-year retrospective observational study (2008–2018) analyzing a cohort of 128 women who suffered from pregnancy fetal loss (>20 weeks of gestational age) with histological evidence of placental infarction. All the women tested negative for congenital and/or acquired thrombophilia. In their subsequent pregnancies, 55 received prophylaxis with acetylsalicylic acid (ASA) only and 73 received ASA plus low molecular weight heparin (LMWH).Results Overall, one-third of all pregnancies (31%) had adverse outcomes related to placental dysfunction: pre-term births (25% <37 weeks, 5.6% <34 weeks), newborns with birth weight <2500 g (17%), and newborns small for gestational age (5%). The prevalence of placental abruption, early and/or severe preeclampsia, and fetal loss >20 weeks were 6%, 5%, and 4% respectively. We found a risk reduction for combination therapy (ASA plus LMWH) compared with ASA alone for delivery <34 weeks (RR 0.11, 95% CI: 0.01–0.95 p = 0.045) and a trend for the prevention of early/severe preeclampsia (RR 0.14, 95% CI: 0.01–1.18, p = 0.0715), while no statistically significant difference was observed for composite outcomes (RR 0.51, 95%CI: 0.22–1.19, p = 0.1242). An absolute risk reduction of 5.31% was observed for the ASA plus LMWH group. Multivariate analysis confirmed a risk reduction for delivery <34 weeks (RR 0.32, 95% CI 0.16–0.96 p = 0.041).Conclusion In our study population, the risk of recurrence of placenta-mediated pregnancy complications is substantial, even in the absence of maternal thrombophilic conditions. A reduction of the risk of delivery <34 weeks was detected in the ASA plus LMWH group.
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Borella et al. (2023) conducted an observational in History of late fetal loss and placental infarction without thrombophilia (n=128). ASA plus low molecular weight heparin (LMWH) vs. Acetylsalicylic acid (ASA) only was evaluated on Composite outcomes (RR 0.51, 95% CI 0.22-1.19, p=0.1242). ASA plus LMWH did not reduce composite adverse pregnancy outcomes compared to ASA alone, but reduced the risk of delivery <34 weeks.
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