Factor V Leiden, heparin, and aspirin

[expert@preeclampsia.org]

Hello wonderful experts. Many of us benefit from the generous time you take to answer our questions. I had severe preeclampsia at 26 and 29 weeks in 1994 & 1997. I was recently diagnosed with FVL, heterozygous. I have access to a scholarly database and have done quite a bit of research on the prevalence of clotting disorders in women who have experienced severe preeclampsia, remote from term. It also appears that treatment with LMWH (low molecular weight heparin) and low dose aspirin are showing better outcomes in subsequent pregnancies. I realize that there will need to be many more studies, randomized, double blind, etc. before this could be evidence based, but what are your thoughts? When I asked my Perinatolgist what his experience was with this, he gave me his opinion based on experience in his practice and told me he was seeing good outcomes with this therapy regimen. What's the latest evidence that you find supports this and what feelings do you have in general about this treatment? I have a new partner (5 years new) and want to try for a child of our own.

Again, thank you for your thoughtful reply.

[expert@preeclampsia.org]

Given a patient with heterozygosity for Factor V Leiden, I want to know whether she has any other thrombophilic risk involving a prothrombin gene mutation especially (or any other) and whether or not she has had a prior thromboembolic event. If she has neither, I would consider not using prophylactic heparin; if she has both, she needs the full Monty. In between is the second thrombophilia absent any thrombolic event history, which merits prophylactic heparin. Whether low dose aspirin makes any difference, I am not convinced but at the least I would put the patient on that from the beginning of pregnancy and thereafter until postpartum. It might matter if the father has an underlying thrombophilia himself, since the fetus blessed from both sides might increase the risk of recurrent preeclampsia or placenta problems occurring.