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Miscarriages Caused by Blood Coagulation Protein or Platelet Deficits

Sections Miscarriages Caused by Blood Coagulation Protein or Platelet Deficits
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Treatment
Medication
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Medication

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, 4]}Treatment of patients with thrombotic disorders is with aspirin, heparin, or low-molecular weight heparin (LMWH).

Aspirin

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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).

Heparin

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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.

Enoxaparin

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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

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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.

Bick RL. Recurrent miscarriage syndrome and infertility caused by blood coagulation protein or platelet defects. Hematol Oncol Clin North Am. 2000 Oct. 14(5):1117-31. [QxMD MEDLINE Link].
Practice Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org. Definitions of infertility and recurrent pregnancy loss: a committee opinion. Fertil Steril. 2020 Mar. 113 (3):533-535. [QxMD MEDLINE Link].
Vomstein K, Aulitzky A, Strobel L, Bohlmann M, Feil K, Rudnik-Schöneborn S, et al. Recurrent Spontaneous Miscarriage: a Comparison of International Guidelines. Geburtshilfe Frauenheilkd. 2021 Jul. 81 (7):769-779. [QxMD MEDLINE Link]. [Full Text].
Redline RW. Thrombophilia and placental pathology. Clin Obstet Gynecol. 2006 Dec. 49(4):885-94. [QxMD MEDLINE Link].
López Ramírez Y, Vivenes M, Miller A, et al. Prevalence of the coagulation factor XIII polymorphism Val34Leu in women with recurrent miscarriage. Clin Chim Acta. 2006 Dec. 374(1-2):69-74. [QxMD MEDLINE Link].
Bick RL, Laughlin HR, Cohen B, et al. Fetal wastage syndrome due to blood protein/platelet defects: results of prevalence studies and treatment outcome with low-dose heparin and low-dose aspirin. Clin Appl Thromb Hemost. 1995. 1:286.
Bick RL, Baker WF. Antiphospholipid syndrome and thrombosis. Semin Thromb Hemost. 1999. 25(3):333-50. [QxMD MEDLINE Link].
Bick RL. The antiphospholipid thrombosis syndromes: a common multidisciplinary medical problem. Clin Appl Thromb Hemost. 1997. 3:270.
Scott JR, Rote NS, Branch DW. Immunologic aspects of recurrent abortion and fetal death. Obstet Gynecol. 1987 Oct. 70(4):645-56. [QxMD MEDLINE Link].
van den Boogaard E, Cohn DM, Korevaar JC, Dawood F, Vissenberg R, Middeldorp S, et al. Number and sequence of preceding miscarriages and maternal age for the prediction of antiphospholipid syndrome in women with recurrent miscarriage. Fertil Steril. 2013 Jan. 99(1):188-92. [QxMD MEDLINE Link].
Chen L, Quan S, Ou XH, Kong L. Decreased endometrial vascularity in patients with antiphospholipid antibodies-associated recurrent miscarriage during midluteal phase. Fertil Steril. 2012 Dec. 98(6):1495-502.e1. [QxMD MEDLINE Link].
Schved JF, Gris JC, Neveu S, Dupaigne D, Mares P. Factor XII congenital deficiency and early spontaneous abortion. Fertil Steril. 1989 Aug. 52(2):335-6. [QxMD MEDLINE Link].
Klein M, Rosen A, Kyrle P, Beck A. [Obstetrical management of dysfibrinogenemia with increased thrombophilia] [German]. Geburtshilfe Frauenheilkd. 1992 Jul. 52(7):442-4. [QxMD MEDLINE Link].
Barkagan ZS, Belykh SI. [Protein C deficiency and the multi-thrombotic syndrome associated ith pregnancy and abortion] [Russian]. Gematol Transfuziol. 1992 Sep-Oct. 37(9-10):35-7. [QxMD MEDLINE Link].
Hellgren M, Tengborn L, Abildgaard U. Pregnancy in women with congenital antithrombin III deficiency: experience of treatment with heparin and antithrombin. Gynecol Obstet Invest. 1982. 14(2):127-41. [QxMD MEDLINE Link].
Simioni P, Lazzaro AR, Coser E, Salmistraro G, Girolami A. Hereditary heparin cofactor II deficiency and thrombosis: report of six patients belonging to two separate kindreds. Blood Coagul Fibrinolysis. 1990 Oct. 1(4-5):351-6. [QxMD MEDLINE Link].
Satoh A, Suzuki K, Takayama E, et al. Detection of anti-annexin IV and V antibodies in patients with antiphospholipid syndrome and systemic lupus erythematosus. J Rheumatol. 1999 Aug. 26(8):1715-20. [QxMD MEDLINE Link].
Gris JC, Neveu S, Mares P, et al. Plasma fibrinolytic activators and their inhibitors in women suffering from early recurrent abortion of unknown etiology. J Lab Clin Med. 1993 Nov. 122(5):606-15. [QxMD MEDLINE Link].
Glueck CJ, Wang P, Fontaine RN, et al. Plasminogen activator inhibitor activity: an independent risk factor for the high miscarriage rate during pregnancy in women with polycystic ovary syndrome. Metabolism. 1999 Dec. 48(12):1589-95. [QxMD MEDLINE Link].
Sokol J, Biringer K, Skerenova M, Hasko M, Bartosova L, Stasko J, et al. Platelet aggregation abnormalities in patients with fetal losses: the GP6 gene polymorphism. Fertil Steril. 2012 Nov. 98(5):1170-4. [QxMD MEDLINE Link].
Kubisz P, Stanciakova L, Stasko J, Dobrotova M, Skerenova M, Ivankova J, et al. Sticky platelet syndrome: an important cause of life-threatening thrombotic complications. Expert Rev Hematol. 2016 Jan. 9 (1):21-35. [QxMD MEDLINE Link].
Amengual O, Atsumi T, Khamashta MA, Hughes GR. Advances in antiphospholipid (Hughes') syndrome. Ann Acad Med Singapore. 1998 Jan. 27(1):61-6. [QxMD MEDLINE Link].
Bick RL. Antiphospholipid thrombosis syndromes: etiology, pathophysiology, diagnosis and management. Int J Hematol. 1997 Apr. 65(3):193-213. [QxMD MEDLINE Link].
Bick RL, Baker WF Jr. The antiphospholipid and thrombosis syndromes. Med Clin North Am. 1994 May. 78(3):667-84. [QxMD MEDLINE Link].
Bick RL. Recurrent miscarriage syndrome and infertility caused by blood coagulation protein/platelet defects. Bick RL, Frenkel EP, Baker WF, Sarode R, eds. Hematologic Complications in Obstetrics, Pregnancy, and Gynecology. Cambridge, UK: Cambridge University Press; 2006. 55-74.
Festin MR, Limson GM, Maruo T. Autoimmune causes of recurrent pregnancy loss. Kobe J Med Sci. 1997 Oct. 43(5):143-57. [QxMD MEDLINE Link].
Santos TDS, Ieque AL, de Carvalho HC, Sell AM, Lonardoni MVC, Demarchi IG, et al. Antiphospholipid syndrome and recurrent miscarriage: A systematic review and meta-analysis. J Reprod Immunol. 2017 Sep. 123:78-87. [QxMD MEDLINE Link].
Khamashta MA. Management of thrombosis and pregnancy loss in the antiphospholipid syndrome. Lupus. 1998. 7 suppl 2:S162-5. [QxMD MEDLINE Link].
Bick RL, Hoppensteadt D. Recurrent miscarriage syndrome and infertility due to blood coagulation protein/platelet defects: a review and update. Clin Appl Thromb Hemost. 2005 Jan. 11(1):1-13. [QxMD MEDLINE Link].
Roussev RG, Kaider BD, Price DE, Coulam CB. Laboratory evaluation of women experiencing reproductive failure. Am J Reprod Immunol. 1996 Apr. 35(4):415-20. [QxMD MEDLINE Link].
Oshiro BT, Silver RM, Scott JR, Yu H, Branch DW. Antiphospholipid antibodies and fetal death. Obstet Gynecol. 1996 Apr. 87(4):489-93. [QxMD MEDLINE Link].
Granger KA, Farquharson RG. Obstetric outcome in antiphospholipid syndrome. Lupus. 1997. 6(6):509-13. [QxMD MEDLINE Link].
Borrelli AL, Brillante M, Borzacchiello C, Berlingieri P. Hemocoagulative pathology and immunological recurrent abortion. Clin Exp Obstet Gynecol. 1997. 24(1):39-40. [QxMD MEDLINE Link].
Hellan M, Kühnel E, Speiser W, Lechner K, Eichinger S. Familial lupus anticoagulant: a case report and review of the literature. Blood Coagul Fibrinolysis. 1998 Mar. 9(2):195-200. [QxMD MEDLINE Link].
Ogasawara M, Aoki K, Matsuura E, Sasa H, Yagami Y. Anti beta 2 glycoprotein I antibodies and lupus anticoagulant in patients with recurrent pregnancy loss: prevalence and clinical significance. Lupus. 1996 Dec. 5(6):587-92. [QxMD MEDLINE Link].
Mitic G, Novakov Mikic A, Povazan L, Mitreski A, Kopitovic V, Vejnovic T. Thromboprophylaxis implementation during pregnancy in women with recurrent foetal losses and thrombophilia. Med Pregl. 2011 Sep-Oct. 64(9-10):471-5. [QxMD MEDLINE Link].
McNamee K, Dawood F, Farquharson RG. Thrombophilia and early pregnancy loss. Best Pract Res Clin Obstet Gynaecol. 2011 Nov 11. [QxMD MEDLINE Link].
Aznar J, Villa P, España F, et al. Activated protein C resistance phenotype in patients with antiphospholipid antibodies. J Lab Clin Med. 1997 Aug. 130(2):202-8. [QxMD MEDLINE Link].
Schultz DR. Antiphospholipid antibodies: basic immunology and assays. Semin Arthritis Rheum. 1997 Apr. 26(5):724-39. [QxMD MEDLINE Link].
Amengual O, Atsumi T, Khamashta MA, Hughes GR. The role of the tissue factor pathway in the hypercoagulable state in patients with the antiphospholipid syndrome. Thromb Haemost. 1998 Feb. 79(2):276-81. [QxMD MEDLINE Link].
Martini A, Ravelli A. The clinical significance of antiphospholipid antibodies. Ann Med. 1997 Apr. 29(2):159-63. [QxMD MEDLINE Link].
Bussen SS, Steck T. Thyroid antibodies and their relation to antithrombin antibodies, anticardiolipin antibodies and lupus anticoagulant in women with recurrent spontaneous abortions (antithyroid, anticardiolipin and antithrombin autoantibodies and lupus anticoagulant in habitual aborters). Eur J Obstet Gynecol Reprod Biol. 1997 Aug. 74(2):139-43. [QxMD MEDLINE Link].
Rand JH, Wu XX. Antibody-mediated disruption of the annexin-V antithrombotic shield: a new mechanism for thrombosis in the antiphospholipid syndrome. Thromb Haemost. 1999 Aug. 82(2):649-55. [QxMD MEDLINE Link]. [Full Text].
Rand JH, Wu XX, Andree HA, et al. Antiphospholipid antibodies accelerate plasma coagulation by inhibiting annexin-V binding to phospholipids: a "lupus procoagulant" phenomenon. Blood. 1998 Sep 1. 92(5):1652-60. [QxMD MEDLINE Link]. [Full Text].
Rauch J. Lupus anticoagulant antibodies: recognition of phospholipid-binding protein complexes. Lupus. 1998. 7 suppl 2:S29-31. [QxMD MEDLINE Link].
Rote NS, Vogt E, DeVere G, Obringer AR, Ng AK. The role of placental trophoblast in the pathophysiology of the antiphospholipid antibody syndrome. Am J Reprod Immunol. 1998 Feb. 39(2):125-36. [QxMD MEDLINE Link].
Vogt E, Ng AK, Rote NS. Antiphosphatidylserine antibody removes annexin-V and facilitates the binding of prothrombin at the surface of a choriocarcinoma model of trophoblast differentiation. Am J Obstet Gynecol. 1997 Oct. 177(4):964-72. [QxMD MEDLINE Link].
Gris JC, Ripart-Neveu S, Maugard C, et al. Respective evaluation of the prevalence of haemostasis abnormalities in unexplained primary early recurrent miscarriages. The Nimes Obstetricians and Haematologists (NOHA) Study. Thromb Haemost. 1997 Jun. 77(6):1096-103. [QxMD MEDLINE Link].
Tal J, Schliamser LM, Leibovitz Z, Ohel G, Attias D. A possible role for activated protein C resistance in patients with first and second trimester pregnancy failure. Hum Reprod. 1999 Jun. 14(6):1624-7. [QxMD MEDLINE Link]. [Full Text].
Kutteh WH, Park VM, Deitcher SR. Hypercoagulable state mutation analysis in white patients with early first-trimester recurrent pregnancy loss. Fertil Steril. 1999 Jun. 71(6):1048-53. [QxMD MEDLINE Link].
Bokarewa MI, Bremme K, Blombäck M. Arg506-Gln mutation in factor V and risk of thrombosis during pregnancy. Br J Haematol. 1996 Feb. 92(2):473-8. [QxMD MEDLINE Link].
Brenner B, Mandel H, Lanir N, et al. Activated protein C resistance can be associated with recurrent fetal loss. Br J Haematol. 1997 Jun. 97(3):551-4. [QxMD MEDLINE Link].
Rai R, Regan L, Hadley E, Dave M, Cohen H. Second-trimester pregnancy loss is associated with activated C resistance. Br J Haematol. 1996 Feb. 92(2):489-90. [QxMD MEDLINE Link].
Grandone E, Margaglione M, Colaizzo D, et al. Factor V Leiden is associated with repeated and recurrent unexplained fetal losses. Thromb Haemost. 1997 May. 77(5):822-4. [QxMD MEDLINE Link].
Ridker PM, Miletich JP, Buring JE, et al. Factor V Leiden mutation as a risk factor for recurrent pregnancy loss. Ann Intern Med. 1998 Jun 15. 128(12 pt 1):1000-3. [QxMD MEDLINE Link]. [Full Text].
Poort SR, Rosendaal FR, Reitsma PH, Bertina RM. A common genetic variation in the 3'-untranslated region of the prothrombin gene is associated with elevated plasma prothrombin levels and an increase in venous thrombosis. Blood. 1996 Nov 15. 88(10):3698-703. [QxMD MEDLINE Link]. [Full Text].
Brenner B, Sarig G, Weiner Z, et al. Thrombophilic polymorphisms are common in women with fetal loss without apparent cause. Thromb Haemost. 1999 Jul. 82(1):6-9. [QxMD MEDLINE Link]. [Full Text].
Bick RL. Antiphospholipid syndrome in pregnancy. Hematol Oncol Clin North Am. 2008 Feb. 22(1):107-20, vii. [QxMD MEDLINE Link].
Dossenbach-Glaninger A, van Trotsenburg M, Dossenbach M, et al. Plasminogen activator inhibitor 1 4G/5G polymorphism and coagulation factor XIII Val34Leu polymorphism: impaired fibrinolysis and early pregnancy loss. Clin Chem. 2003 Jul. 49(7):1081-6. [QxMD MEDLINE Link]. [Full Text].
Asahina T, Kobayashi T, Takeuchi K, Kanayama N. Congenital blood coagulation factor XIII deficiency and successful deliveries: a review of the literature. Obstet Gynecol Surv. 2007 Apr. 62(4):255-60. [QxMD MEDLINE Link].
Matsubayashi H, Sugi T, Suzuki T, et al. Decreased factor XII activity is associated with recurrent IVF-ET failure. Am J Reprod Immunol. 2008 Apr. 59(4):316-22. [QxMD MEDLINE Link].
Pauer HU, Burfeind P, Köstering H, Emons G, Hinney B. Factor XII deficiency is strongly associated with primary recurrent abortions. Fertil Steril. 2003 Sep. 80(3):590-4. [QxMD MEDLINE Link].
Jones DW, Gallimore MJ, Winter M. Antibodies to factor XII: a possible predictive marker for recurrent foetal loss. Immunobiology. 2003. 207(1):43-6. [QxMD MEDLINE Link].
Sugi T, Makino T. Antiphospholipid antibodies and kininogens in pathologic pregnancies: a review. Am J Reprod Immunol. 2002 May. 47(5):283-8. [QxMD MEDLINE Link].
Iinuma Y, Sugiura-Ogasawara M, Makino A, Ozaki Y, Suzumori N, Suzumori K. Coagulation factor XII activity, but not an associated common genetic polymorphism (46C/T), is linked to recurrent miscarriage. Fertil Steril. 2002 Feb. 77(2):353-6. [QxMD MEDLINE Link].
Yamada H, Kato EH, Ebina Y, et al. Factor XII deficiency in women with recurrent miscarriage. Gynecol Obstet Invest. 2000. 49(2):80-3. [QxMD MEDLINE Link].
Valnícek S, Vacl J, Mrázová M, et al. [Hemotherapeutic safeguarding of induced abortion in inborn proconvertin insufficiency (hemagglutination factor VII) using exchange plasmapheresis] [German]. Zentralbl Gynakol. 1972 Jul 22. 94(29):931-5. [QxMD MEDLINE Link].
Nelson DB, Ness RB, Grisso JA, Cushman M. Influence of hemostatic factors on spontaneous abortion. Am J Perinatol. 2001 Jun. 18(4):195-201. [QxMD MEDLINE Link].
Slunský R. [Personal experiences with the antifibrinolytic PAMBA in obstetrics and gynecology] [German]. Zentralbl Gynakol. 1970 Mar 21. 92(12):364-7. [QxMD MEDLINE Link].
Owen CA Jr, Henriksen RA, McDuffie FC, Mann KG. Prothrombin Quick. A newly identified dysprothrombinemia. Mayo Clin Proc. 1978 Jan. 53(1):29-33. [QxMD MEDLINE Link].
Kamimoto Y, Wada H, Ikejiri M, Nakatani K, Sugiyama T, Osato K, et al. Hypofibrinogenemia and the α-Fibrinogen Thr312Ala Polymorphism may be Risk Factors for Early Pregnancy Loss. Clin Appl Thromb Hemost. 2017 Jan. 23 (1):52-57. [QxMD MEDLINE Link]. [Full Text].
Evron S, Anteby SO, Brzezinsky A, Samueloff A, Eldor A. Congenital afibrinogenemia and recurrent early abortion: a case report. Eur J Obstet Gynecol Reprod Biol. 1985 May. 19(5):307-11. [QxMD MEDLINE Link].
Mammen EF. Congenital abnormalities of the fibrinogen molecule. Semin Thromb Hemost. 1974. 1:184.
Dimitriadis E, Menkhorst E, Saito S, Kutteh WH, Brosens JJ. Recurrent pregnancy loss. Nat Rev Dis Primers. 2020 Dec 10. 6 (1):98. [QxMD MEDLINE Link].
Sher G, Feinman M, Zouves C, et al. High fecundity rates following in-vitro fertilization and embryo transfer in antiphospholipid antibody seropositive women treated with heparin and aspirin. Hum Reprod. 1994 Dec. 9(12):2278-83. [QxMD MEDLINE Link].
Rosove MH, Tabsh K, Wasserstrum N, et al. Heparin therapy for pregnant women with lupus anticoagulant or anticardiolipin antibodies. Obstet Gynecol. 1990 Apr. 75(4):630-4. [QxMD MEDLINE Link].
Brown HL. Antiphospholipid antibodies and recurrent pregnancy loss. Clin Obstet Gynecol. 1991 Mar. 34(1):17-26. [QxMD MEDLINE Link].
Perino A, Barba G, Cimino C, et al. Immunological problems in the recurrent abortion syndrome. Acta Eur Fertil. 1989 Jul-Aug. 20(4):199-202. [QxMD MEDLINE Link].
Many A, Pauzner R, Carp H, Langevitz P, Martinowitz U. Treatment of patients with antiphospholipid antibodies during pregnancy. Am J Reprod Immunol. 1992 Oct-Dec. 28(3-4):216-8. [QxMD MEDLINE Link].
Lubbe WF, Liggins GC. Role of lupus anticoagulant and autoimmunity in recurrent fetal loss. Semin Reprod Endocrinol. 1988. 6:181-90.
Lin QD. [Investigation of the association between autoantibodies and recurrent abortions] [Chinese]. Zhonghua Fu Chan Ke Za Zhi. 1993 Nov. 28(11):674-7, 702. [QxMD MEDLINE Link].
Cowchock FS, Reece EA, Balaban D, Branch DW, Plouffe L. Repeated fetal losses associated with antiphospholipid antibodies: a collaborative randomized trial comparing prednisone with low-dose heparin treatment. Am J Obstet Gynecol. 1992 May. 166(5):1318-23. [QxMD MEDLINE Link].
Landy HJ, Kessler C, Kelly WK, Weingold AB. Obstetric performance in patients with the lupus anticoagulant and/or anticardiolipin antibodies. Am J Perinatol. 1992 May. 9(3):146-51. [QxMD MEDLINE Link].
Semprini AE, Vucetich A, Garbo S, Agostoni G, Pardi G. Effect of prednisone and heparin treatment in 14 patients with poor reproductive efficiency related to lupus anticoagulant. Fetal Ther. 1989. 4 suppl 1:73-6. [QxMD MEDLINE Link].
Kutteh WH. Antiphospholipid antibody-associated recurrent pregnancy loss: treatment with heparin and low-dose aspirin is superior to low-dose aspirin alone. Am J Obstet Gynecol. 1996 May. 174(5):1584-9. [QxMD MEDLINE Link].
Zhang T, Ye X, Zhu T, Xiao X, Liu Y, Wei X, et al. Antithrombotic Treatment for Recurrent Miscarriage: Bayesian Network Meta-Analysis and Systematic Review. Medicine (Baltimore). 2015 Nov. 94 (45):e1732. [QxMD MEDLINE Link]. [Full Text].
Parke A. The role of IVIG in the management of patients with antiphospholipid antibodies and recurrent pregnancy losses. Clin Rev Allergy. 1992 Spring-Summer. 10(1-2):105-18. [QxMD MEDLINE Link].
Sciascia S, Hunt BJ, Talavera-Garcia E, Lliso G, Khamashta MA, Cuadrado MJ. The impact of hydroxychloroquine treatment on pregnancy outcome in women with antiphospholipid antibodies. Am J Obstet Gynecol. 2016 Feb. 214 (2):273.e1-8. [QxMD MEDLINE Link].
Toschi V, Motta A, Castelli C, et al. High prevalence of antiphosphatidylinositol antibodies in young patients with cerebral ischemia of undetermined cause. Stroke. 1998 Sep. 29(9):1759-64. [QxMD MEDLINE Link]. [Full Text].
Zangari M, Lockwood CJ, Scher J, Rand JH. Prothrombin activation fragment (F1.2) is increased in pregnant patients with antiphospholipid antibodies. Thromb Res. 1997 Feb 1. 85(3):177-83. [QxMD MEDLINE Link].
España F, Villa P, Mira Y, et al. Factor V Leiden and antibodies against phospholipids and protein S in a young woman with recurrent thromboses and abortion. Haematologica. 1999 Jan. 84(1):80-4. [QxMD MEDLINE Link]. [Full Text].

Media Gallery

Defects causing recurrent miscarriage.
Dallas/Fort Worth Metroplex (DFW Metroplex) flow protocol.

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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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Sections Miscarriages Caused by Blood Coagulation Protein or Platelet Deficits
Overview
Presentation
DDx
Workup
Treatment
Medication
Media Gallery
Tables
References

Miscarriages Caused by Blood Coagulation Protein or Platelet Deficits Medication

Medication Summary

Analgesic, Salicylate

Aspirin

Aspirin

Anticoagulant

Heparin

Heparin

Low Molecular Weight Heparin

Enoxaparin

Enoxaparin

Dalteparin

Dalteparin

Miscarriages Caused by Blood Coagulation Protein or Platelet Deficits Medication

Medication Summary

Analgesic, Salicylate

Aspirin

Aspirin

Anticoagulant

Heparin

Heparin

Low Molecular Weight Heparin

Enoxaparin

Enoxaparin

Dalteparin

Dalteparin

References

Tables

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