Impact of heparin-aspirin therapy in patients with recurrent pregnancy loss characterized by thrombophilia resistant to low-dose aspirin therapy: A retrospective study.

IF 2.7 3区 医学 Q2 OBSTETRICS & GYNECOLOGY
Reproductive Medicine and Biology Pub Date : 2025-03-26 eCollection Date: 2025-01-01 DOI:10.1002/rmb2.12643
Tomoko Ichikawa, Takami Watanabe, Yumene Kubota, Shigeru Matsuda, Daisuke Shigemi, Sayuri Kasano, Ryoko Yokote, Mirei Yonezawa, Nozomi Ouchi, Yasuyuki Negishi, Yoshimitsu Kuwabara, Toshiyuki Takeshita, Shunji Suzuki
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引用次数: 0

Abstract

Purpose: Heparin and aspirin (HA) therapy is used for antiphospholipid syndrome (APS)-associated recurrent pregnancy loss (RPL). Low-dose aspirin (LDA) is recommended for thrombophilic predispositions, such as antiphospholipid antibodies that do not completely meet the Sydney classification criteria for APS, protein S deficiency, factor XII deficiency and increased platelet aggregation. However, no established strategy exists for cases where LDA is ineffective. Therefore, this study aimed to identify the characteristics of RPL cases unresponsive to LDA and to determine whether HA is more effective than LDA in such cases.

Methods: A total of 913 LDA-treated pregnancies were categorized into live births and miscarriages, and their characteristics were retrospectively analyzed.

Results: The live birth rates following one, two, or three or more LDA therapies were 78.5%, 61.5% and 16.7%, respectively. Live birth rates were significantly lower when lupus anticoagulant (LAC) aPTT was positive but did not qualify as obstetric APS following LDA therapy (birth rates: 33.3%, p = 0.048). Three or more LDA therapies decreased the live birth rate, whereas HA therapy significantly increased the live birth rate (p = 0.0019).

Conclusions: HA therapy is recommended over repeated LDA treatment, particularly when LAC aPTT is positive but does not qualify as obstetric APS.

肝素-阿司匹林治疗对以血栓形成为特征的复发性流产患者对低剂量阿司匹林治疗的影响:一项回顾性研究。
目的:肝素和阿司匹林(HA)治疗用于抗磷脂综合征(APS)相关的复发性妊娠丢失(RPL)。低剂量阿司匹林(LDA)被推荐用于嗜血栓易感性,如抗磷脂抗体不完全符合APS、蛋白S缺乏、因子XII缺乏和血小板聚集增加的悉尼分类标准。然而,对于LDA无效的情况,没有既定的策略。因此,本研究旨在确定对LDA无反应的RPL病例的特征,并确定在这种情况下HA是否比LDA更有效。方法:对913例经lda治疗的妊娠分为活产和流产,并对其特点进行回顾性分析。结果:1次、2次、3次及以上LDA治疗后的活产率分别为78.5%、61.5%和16.7%。当狼疮抗凝剂(LAC) aPTT阳性但不符合LDA治疗后的产科APS时,活产率显著降低(出生率:33.3%,p = 0.048)。三种或三种以上LDA治疗降低了活产率,而HA治疗显著提高了活产率(p = 0.0019)。结论:HA治疗优于重复LDA治疗,特别是当LAC aPTT阳性但不符合产科APS标准时。
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来源期刊
CiteScore
5.70
自引率
5.90%
发文量
53
审稿时长
20 weeks
期刊介绍: Reproductive Medicine and Biology (RMB) is the official English journal of the Japan Society for Reproductive Medicine, the Japan Society of Fertilization and Implantation, the Japan Society of Andrology, and publishes original research articles that report new findings or concepts in all aspects of reproductive phenomena in all kinds of mammals. Papers in any of the following fields will be considered: andrology, endocrinology, oncology, immunology, genetics, function of gonads and genital tracts, erectile dysfunction, gametogenesis, function of accessory sex organs, fertilization, embryogenesis, embryo manipulation, pregnancy, implantation, ontogenesis, infectious disease, contraception, etc.
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