Classification
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APS, Hereditary Thrombophilias, Unexplained RPL,. Classification. APS, Metaanalysis of 3 RCT (135 patients), (Empson et al, 2002, including :- Cowchock & Reece, 1997; Pattison et al, 2000; Tulppala et al, 1997), RR = 1.05, (CI, 0.66 - 1.68)

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Classification

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APS,

Hereditary Thrombophilias,

Unexplained RPL,

Classification


APS, Metaanalysis of 3 RCT (135 patients),(Empson et al, 2002, including :- Cowchock & Reece, 1997; Pattison et al, 2000; Tulppala et al, 1997),RR = 1.05, (CI, 0.66 - 1.68)

Unexplained RPL, 3 RCT’s, (Tulppala, et al 1997, Kaandorp, et al 2010, Visser, et al 2011),RR=0.96 (CI, 0.62 -1.46)

Hereditary Thrombophilias, 2 RCT’s, (Kaandorp, et al 2010, Visser, et al 2011),RR=0.68 (CI, 0.33 -1.39)

In RPL, Aspirin has no beneficial effect

Role of Aspirin in RPL


Kutteh et al, 2.45 (1.11-5.44)

Rai et al, 1.88 (1.15-3.08)

Farquharson et al, 1.18 (0.73-1.91)

Overall, 1.65 (1.2-2.27)

0.1

1

10

Metaanalysis on Heparin & LMWH in APS

  • No measurement of 2GP-1 antibodies

  • No correction for chromosomal aberrations

  • No correction for embryonic structural malformations

  • Overall benefit 22%


Heparins in Hereditary Thrombophilias

(71.6%)

(50.6%)

(73.3%)

(58.3%)

Clark: Heparin & Aspirin vs surveillance alone, Kaandorp: Nandoparin & Aspirin vs Placebo

Visser: Enoxaparin & placebo vs Aspirin


12/17

6/7

8/13

26/37

12/26

7/11

3/12

22/49

Anticoagulants in Hereditary Thrombophilia (Carp et al, 2003)

RR=1.87 (95% CI=1.07-3.28)


Heparins in Unexplained RPL

  • No beneficial effect


RCOG Guideline (2012)


ASRM Guideline (2012)


De Jong et al, 2014

  • 9 studies, of 1228 women

  • Assessed enoxaparin or nadroparin or aspirin or a combination of both

  • No beneficial effect found

  • This review does not support the use of anticoagulants in women with unexplained recurrent miscarriage.


Role of Aspirin in APS(Empson et al, 2002)

Aspirin alone did not significantly reduce pregnancy loss,

RR = 1.05, (95% CI, 0.66 - 1.68)


Preconception Aspirin

  • Preconception aspirin was not significantly associated with live birth or pregnancy loss in women with 1 – 2 previous losses.

  • Higher live birth rates in women with a single loss at < 20 weeks during the previous year.

  • Preconception aspirin is not recommended for decrease pregnancy loss or increase live birth rates.


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