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Miscarriages Caused by Blood Coagulation Protein or Platelet Deficits Medication

  • Author: George Ansstas, MD; Chief Editor: Perumal Thiagarajan, MD  more...
 
Updated: Oct 21, 2015
 

Medication Summary

Management of patients with recurrent miscarriage due to hemorrhagic disorders is generally with plasma substitution therapy or, in appropriate disorders, DDAVP (vasopressin) therapy.[1, 2] Treatment of patients with thrombotic disorders is with aspirin, heparin, or low-molecular weight heparin (LMWH).

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Analgesic, Salicylate

Aspirin

 

Antiplatelet effect indicated to decrease risk of thrombosis and pregnancy loss in pregnant women with antiphospholipid antibody (APS) syndrome. Although not proven effective when used alone, most clinicians use aspirin with subcutaneous heparin in pregnant patients with APS. Begin aspirin as soon as conception is attempted.

Inhibits platelet aggregation by inhibiting platelet cyclooxygenase. This, in turn, inhibits conversion of arachidonic acid to PGI2 (potent vasodilator and inhibitor of platelet activation) and thromboxane A2 (potent vasoconstrictor and platelet aggregate).

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Anticoagulant

Heparin

 

Indicated to decrease risk of thrombosis and pregnancy loss in pregnant women with APS.

Augments activity of antithrombin III and prevents conversion of fibrinogen to fibrin. Does not actively lyse but is able to inhibit further thrombogenesis. Prevents re-accumulation of clot after spontaneous fibrinolysis.

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Low Molecular Weight Heparin

Enoxaparin

 

Produced by partial chemical or enzymatic depolymerization of unfractionated heparin (UFH). Binds to antithrombin III, enhancing its therapeutic effect. The heparin-antithrombin III complex binds to and inactivates activated factor X (Xa) and factor II (thrombin).

Does not actively lyse but is able to inhibit further thrombogenesis. Prevents reaccumulation of clot after spontaneous fibrinolysis.

Advantages include intermittent dosing and decreased requirement for monitoring. Heparin anti–factor Xa levels may be obtained if needed to establish adequate dosing.

LMWH differs from UFH by having a higher ratio of antifactor Xa to antifactor IIa compared to UFH.

Prevents DVT, which may lead to pulmonary embolism in patients undergoing surgery who are at risk for thromboembolic complications. Used for prevention in hip replacement surgery (during and following hospitalization), knee replacement surgery, or abdominal surgery in those at risk of thromboembolic complications, or in nonsurgical patients at risk of thromboembolic complications secondary to severely restricted mobility during acute illness.

Used to treat DVT or PE in conjunction with warfarin for inpatient treatment of acute DVT with or without PE or for outpatient treatment of acute DVT without PE.

No utility in checking aPTT (drug has wide therapeutic window and aPTT does not correlate with anticoagulant effect).

Average duration of treatment is 7-14 d.

Indicated to decrease the risk of thrombosis and pregnancy loss in pregnant women with APS.

Dalteparin

 

Enhances inhibition of Factor Xa and thrombin by increasing antithrombin III activity. In addition, preferentially increases inhibition of Factor Xa.

Except in overdoses, no utility exists in checking PT or aPTT because aPTT does not correlate with anticoagulant effect of fractionated LMWH.

Average duration of treatment is 7-14 d.

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Contributor Information and Disclosures
Author

George Ansstas, MD Instructor of Medicine, Attending Physician in Leukemia and Bone Marrow Transplant and Oncology, Washington University School of Medicine

George Ansstas, MD is a member of the following medical societies: American Medical Association

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: Received salary from Medscape for employment. for: Medscape.

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

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

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: GSK Pharmaceuticals,Alexion,Johnson & Johnson Talecris,,Grifols<br/>Received honoraria from all the above companies for speaking and teaching.

Chief Editor

Perumal Thiagarajan, MD Professor, Department of Pathology and Medicine, Baylor College of Medicine; Director, Transfusion Medicine and Hematology Laboratory, Michael E DeBakey Veterans Affairs Medical Center

Perumal Thiagarajan, MD is a member of the following medical societies: American College of Physicians, American Society for Clinical Investigation, Association of American Physicians, American Society for Biochemistry and Molecular Biology, American Heart Association, American Society of Hematology, Royal College of Physicians

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, y 33.3 5.63 49 18
Number of Miscarriages 2.9 2.39 9 2
Table 2. Clotting Disorders Found in the Authors' Population
Antiphospholipid Found Patients With APLS, %
ACLA-IgG only 32.6
ACLA-IgM only 23.4
ACLA-IgA only 7
ACLA-IgG + IgM 3
ACLA-IgG + IgA 1
ACLA IgA + IgM 0
Lupus anticoagulant only 2
ACLA + lupus anticoagulant 2
Subgroup Only (No ACLA or lupus anticoagulant present)  
Antiphosphatidylserine 4
Antiphosphatidylinositol 2
Antiphosphatidylethanolamine 5
Antiphosphatidic acid 5
Antiphosphatidylcholine 7
Antiphosphatidylglycerol 1
Anti-annexin-V 5
B2GP1 0
Hexagonal phospholipid 0
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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