Anticoagulants to prevent placenta-mediated pregna

[caryn]

Controversy exists whether inherited or acquired thrombophilias cause placenta-mediated complications. Small randomized studies with methodological limitations suggest that antepartum anticoagulant prophylaxis will reduce pregnancy loss in women with both acquired and inherited thrombophilia and prior pregnancy loss. There are no published randomized controlled trials examining anticoagulant prophylaxis in thrombophilic women with prior preeclampsia, intrauterine growth restriction or placental abruption. More recently, the benefit of antepartum anticoagulant prophylaxis in women without thrombophilia with prior placenta-mediated pregnancy complications has been suggested in a small pilot randomized trial...

http://www.ncbi.nlm.nih.gov/pubmed/19550316

In other words, we don't really know if thrombophilias are helped by anticoagulants. Yet.

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[mother bear]

I found the trial mentioned in the last sentence above.

http://www.ncbi.nlm.nih.gov/pubmed/19036070?ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

This small pilot randomized trial shows a significant difference in primary outcome in women WITHOUT thrombophilias receiving lovenox and baby aspirin in preventing preeclampsia, placental abruption, fetal growth restriction, and fetal loss? 23 percent down to 5 percent is pretty nice to see... but the conclusion is, as always, more randomized trials are needed.

Er, don't mind me, just doing some last minute research to back up my "I don't wanna do lovenox again" claim.

[beth11]

Confession - I've never been able to figure out how to get to the full text of these articles! It must be just me since mother bear obviously foud it :) Anyone?

[caryn]

Beth, it depends on the publishing house. Some of these are hidden behind a for-profit firewall, and that means you can get them if you have institutional access, but otherwise you've got to pay.

There's actually a huge push in the science community to make these papers available online to everyone, and so some of them -- like the one motherbear just linked -- have buttons somewhere on the abstract page that will take you to the full-text paper once you've found the abstract by searching in PubMed. (They're *usually* -- but not always -- in the middle of the upper right quadrant of the screen.)

[caryn]

Oh, and it seems to me that "I don't *want* to do Lovenox and I understand that this might mean I've got a slightly higher risk" is a perfectly good justification!

I know both Catherine and Laura declined heparin/Lovenox on precisely those grounds with their last pregnancies. I would do the same, because I'm needlephobic, and pass out.

:-)

[neslo]

I'm with Beth! I can read the little abstract for most of these articles - but can never get to the full text. Not that I would understand them anyway...

The MFM I see specializes in Thrombophilias during pregnancy (She's part of the MFM group at a large research hospital). I'm part of some study that she is conducting - but we discussed it so long ago I've completely forgotten exactly what they were looking at. She enrolled me in the study before I even got pregnant again.

[mother bear]

Yeah, I know that my wants trump all, but I wanted to justify to myself what exactly the state of the science was. You know, if they had an actual study on point that was relevant to me (which they don't), that showed a significant difference and benefit, then, yeah, I'd think harder, probably do it.

I did Lovenox last time. I just didn't want to do it again, knowing what it entailed (pain and suffering plus $180 per month out of pocket) without just a wee bit more "proof" of benefit, or being enrolled in a study. "Well, I think that 90% of the MFMs in this office would recommend that you take it" (actual quote, by the way) just doesn't cut it for my own very personal risk-benefit analysis.

[caryn]

Yes, exactly. I'd suck it up for proven benefit, lol!