Miscarriages Caused by Blood Coagulation Protein or Platelet Deficits Medication

  • Author: Rodger L Bick†, MD, PhD, FACP; Chief Editor: Emmanuel C Besa, MD   more...
 
Updated: Nov 28, 2011
 
 

Medication Summary

See the 2002 US-FDA Medwatch Alert regarding Lovenox. The alert is summarized below.

Prosthetic heart valve warnings

Lovenox Injection is not recommended for patients with prosthetic heart valves for thromboprophylaxis. Prosthetic heart valve thrombosis has been reported in these patients, some of whom were pregnant women in whom thrombosis led to maternal and fetal deaths. The thromboembolism risk may be higher in pregnant women with prosthetic heart valves (see Pregnancy Precautions, below).

Pregnancy precautions

  • Teratogenic effects: Congenital anomalies in infants of women who received enoxaparin during pregnancy include cerebral anomalies, limb anomalies, hypospadias, peripheral vascular malformation, fibrotic dysplasia, and cardiac defect. The incidence is not higher than in the general population, and cause and effect are not established.
  • Nonteratogenic effects
    • Fetal deaths have occurred in pregnant women who received Lovenox Injection. A cause-and-effect relationship has not been established in these cases. Pregnant women who take anticoagulants, including enoxaparin, have a greater risk for bleeding at any site, which may lead to fetal or maternal death. Carefully monitor pregnant women on enoxaparin. Inform pregnant women and women with childbearing potential of the potential hazard of enoxaparin in pregnancy to the mother and fetus.
    • In one clinical study of pregnant women with prosthetic heart valves, maternal and fetal death occurred in 2 of 7 women given enoxaparin (1 mg/kg bid) to reduce the risk of thromboembolism in whom clots formed that blocked their prosthetic heart valves. Prosthetic valve thrombosis has occurred in pregnant women with prosthetic heart valves who were taking enoxaparin for thromboprophylaxis, resulting in maternal death or surgical interventions. Lovenox Injection is not recommended for thromboprophylaxis in pregnant women with prosthetic heart valves (see Prosthetic Heart Valve Warnings, above).

Adverse reactions and ongoing safety surveillance

Since 1993, more than 80 incidents of epidural or spinal hematoma formation have been reported with spinal/epidural anesthesia or spinal puncture in patients receiving Lovenox Injection.

 
Contributor Information and Disclosures
Author

Rodger L Bick†, MD, PhD, FACP  Former Clinical Professor of Medicine, University of Texas Southwestern Medical Center; Former Director, Dallas and Pacific Thrombosis Hemostasis and Vascular Medicine Clinical Center

Rodger L Bick†, MD, PhD, FACP is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Blood Banks, American Cancer Society, American College of Angiology, American College of Physicians, American Geriatrics Society, American Heart Association, American Medical Association, American Society for Clinical Pathology, American Society of Hematology, Association of Clinical Scientists, California Medical Association, California Thoracic Society, International College of Angiology, International Society of Hematology, International Society on Thrombosis and Haemostasis, New York Academy of Sciences, and Southwest Oncology Group

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Ronald A Sacher, MB, BCh, MD, FRCPC  Professor, Internal Medicine and Pathology, Director, Hoxworth Blood Center, University of Cincinnati Academic Health Center

Ronald A Sacher, MB, BCh, MD, FRCPC is a member of the following medical societies: American Association for the Advancement of Science, American Association of Blood Banks, American Clinical and Climatological Association, American Society for Clinical Pathology, American Society of Hematology, College of American Pathologists, International Society of Blood Transfusion, International Society on Thrombosis and Haemostasis, and Royal College of Physicians and Surgeons of Canada

Disclosure: Glaxo Smith Kline Honoraria Speaking and teaching; Talecris Honoraria Board membership

Rajalaxmi McKenna, MD, FACP  Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems

Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis

Disclosure: Nothing to disclose.

Chief Editor

Emmanuel C Besa, MD  Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University

Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Clinical Oncology, American Society of Hematology, and New York Academy of Sciences

Disclosure: Nothing to disclose.

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Defects causing recurrent miscarriage.
Dallas/Fort Worth Metroplex (DFW Metroplex) flow protocol.
Table 1. Characteristics of the First 351 Women Referred for Hemostasis Evaluation
Patient Characteristics (All 351 Patients) Mean Standard Deviation Maximum Minimum
Age, y33.35.634918
Number of Miscarriages2.92.3992
Table 2. Clotting Disorders Found in the Authors' Population
Antiphospholipid Found Patients With APLS, %
ACLA-IgG only32.6
ACLA-IgM only23.4
ACLA-IgA only7
ACLA-IgG + IgM3
ACLA-IgG + IgA1
ACLA IgA + IgM0
Lupus anticoagulant only2
ACLA + lupus anticoagulant2
Subgroup Only



(No ACLA or lupus anticoagulant present)



Antiphosphatidylserine4
Antiphosphatidylinositol2
Antiphosphatidylethanolamine5
Antiphosphatidic acid5
Antiphosphatidylcholine7
Antiphosphatidylglycerol1
Anti–annexin-V5
B2GP10
Hexagonal phospholipid0
Total
(9 Patients had ACLA + a subgroup antibody)
Total with only a subgroup antibody
APLS patients with only a subgroup antibody, %29
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