Effects of antikoagulant therapy on pregnancy outcomes in patients with thrombophilia and previous poor obstetric outcomes

Placenta related complications are leading causes of mortality and morbidity in pregnancy. Preeclampsia, placental abruption, intrauterine growth restriction, recurrent pregnancy losses and intrauterine fetal death are some of these placenta related obstetric complications and thrombophilias are associated with these complications. The aim of this study is to investigate effects of anticoagulant therapy on pregnancy outcomes in patients with thrombophilia and previous poor obstetric outcomes.Medical records of patient who were seen in the Department of Obstetrics and Gynecology at Gazi University Medical Faculty between 2006 and 2009 with at least one of the following diagnoses on their obstetric records were screened: preeclampsia, IUGR, IUFD, placental abruption, and recurrent pregnancy losses. Among these, 204 of them who were carrying at least one hereditary thrombophilia mutation were included in this study. Patients were divided in two groups depending on history of whether or not anticoagulation therapy is used in their last pregnancies. Treatment group was also subdivided in aspirin (80mg/ day), low molecular weight heparin (4000IU/ day) and LMWH + aspirin groups. These groups were compared in gestational age, birthweight, Apgar scores, live birth rate, stillbirth rate, neonatal demise, abortus rates, obstetric complications, mode of delivery and admission rates to the neonatal intensive care unit. Treatment and treatment subgroups? effects on pregnancy outcomes were investigated in each group of patients with different thrombophilia type. Also in obstetric complications, recurrent pregnancy loss group was studied seperately and effects of anticoagulation treatment and treatment subgroups on pregnancy outcomes were investigated.When treated and untreated groups compared for obstetric complications, no complications were observed in 81.9% in treated group and 50% in untreated group (p<0.001). When treated and untreated groups were compared in live birth rate, stilbirth, neonatal demise and abortus rates, live birth rate was 91% in treated group, 60% in untreated group; abortus rate was 40% in untreated group, 6.3% in treated group (p<0.001). Gestational age, first and 5th minute Apgar scores were significantly higher in treated group when compared to untreated group. No significant differences could be observed among different treatment subgroups in terms of these parameters. However, observed effects in treatment group may be due to LMWH, since no difference were observed between aspirin-takers group and untreated group.For pregnant women with thrombophilia and previous poor obstetric outcomes anticoagulant therapy provides safe and effective obstetric outcomes. However, when potential risks and costs considered, especially for LMWH, there is a need for well designed randomized controlled trials demonstrating risk-benefit profiles before their routine use in practice.Key Words: Obstetric complications, thrombophilia, anticoagulant therapy