value of anticoagulants like heparin or Lovenox?

[expert@preeclampsia.org]

Could I get some recent expert commentary on the value of low molecular weight heparin or Lovenox in women with a history of preeclampsia?

[expert@preeclampsia.org]

Unless there is a current medical indication for prophylactic or therapeutic anticoagulation in a patient with a history of preeclampsia in the past, it has no value or place.

[expert@preeclampsia.org]

Heparin to prevent preeclampsia has been in and out of the literature since championed it over 30 years ago in uncontrolled trials. The current bandleader is **** whose studies have either been retrospective or when prospective small. Some studies have combined aspirin and heparin claiming success. My take is all these studies suffer from the fact that, of course, the protocols require all patients to be multiparas where clinical definitions are less sure (that is the prophlaxis follows an index definition of PE), plus the fact that some exacerbations of thrombophilias mimic preeclampsia. In essence the question of benefit is actually unanswered and the length of time we have been hearing the pro and cons suggests benefits will prove small and remember the Rx requires daily injections.

[expert@preeclampsia.org]

I concur with ****. The more this topic is studied the less certainty we have. As the PI of an ongoing RCT designed to help answer this question says, heparin is not candy - either in terms of daily inconvenience and pain, cost, and risks (heparin-induced thrombocytopoenia in particular).

[expert@preeclampsia.org]

I think it is too complicated to have an opinion on the website on this issue; Each case is so different that it is dangerous to extrapolate from one to another.

[expert@preeclampsia.org]

I agree with most of what has been said. It is very difficult to make a global response.

• The early excitement about a thrombophilia and the etiology of preeclampsia has waned. We have, in general, tested a lot and not found much that made a difference.
• For a few patients (eg. those with true antiphospholipid syndrome and maternal clotting) anticoagulation is critical for the protection of maternal health.
• Heparins have some anti inflammatory action and to the extent that preeclampsia is an immune activated disease process - they might be helpful - but largely without supporting data.
• For women with early severe recurrent IUGR that devolves into preeclampsia (sometimes labeled placental floor infarction) LMWH is part of the kitchen sink that is thrown at them with some positive appearing results. Could be classified as acts of quiet desperation.

I suspect that most of us would agree that ROUTINE treatment of every women with a history of prior preterm preeclampsia is not indicated.

[expert@preeclampsia.org]

I am not aware of any benefit based on scientific evidence. It is not a good way to treat women considering daily injection, side effects, and costs. Any suggested benefit will be based on junk science and dogma. We need to wait the results of a large trial from France.

[expert@preeclampsia.org]

I agree with ****.

[expert@preeclampsia.org]

Sorry I have not much to add not an area of my knowledge.