has been shown to be safe and effective anticoagulant in the
management of RPL in thrombophilic disorders (7). A study
comparing the antithrombotic properties of enoxaparin,
tinzaparin and deltaparin revealed significant differences in
anti-FXa and anti-FIIa activity between products, but the
clinical relevance of these biochemical and pharmacologic
differences between LMWH molecules is still questionable
All authors of this study have a complete contribution for
data collection, data analyses and manuscript writing.
. ESHRE Guideline Group on RPL, Bender Atik R,
Christiansen OB, Elson J, Kolte AM, Lewis S, Middeldorp
S, Nelen W, Peramo B, Quenby S, Vermeulen N. ESHRE
guideline: recurrent pregnancy loss. Human Reproduction
As per our present study, the use of LMWH in the first
trimester of pregnancy appears to be safe for mother and
neonate; maternal bleeding, venous/arterial thrombotic
episodes or heparin induced thrombocytopenia were not
observed (Table 3 and 4). Clinical evidence suggests that
women with thrombophilia have an increased risk of pregnancy
loss and complications such as preeclampsia, placental
abruption, and IUGR (18, 19). Pregnancy complications
following enoxaparin prophylaxis in women with
thrombophilia and RPL is beneficial in terms of both fetal and
maternal health. Previous smaller studies have reported the
benefits of prophylaxis in improving pregnancy outcomes in
women with RPL and thrombophilia (20, 21). Similarly in our
study we did not notice any adverse maternal or fetal outcome
when comparing both groups. The use of LMWH in pregnancy
does not appear to have any increased risk of IUGR, IUD, pre-
eclampsia or preterm deliveries as results of our study (Table
Practice Committee of the American Society for
Reproductive Medicine. Definitions of infertility and
recurrent pregnancy loss: a committee opinion. Fertility and
. Brenner B, Hoffman R, Blumenfeld Z et al. J. Gestational
outcome in thrombophilic women with recurrent pregnancy
loss treated by enoxaparin. Thromb Haemost. 2000;83:693-
. Fouda UM, Sayed AM, Abdou AM, et al. Enoxaparin versus
unfractionated heparin in the management of recurrent
abortion secondary to antiphospholipid syndrome.
International Journal of Gynaecology & Obstetrics.
2011;112(3):211-215. doi: 10.1016/j.ijgo.2010.09.010.
. Dendrinos S, Kalogiroul I, Makrakis E, Theodoridis T.
Safety and effectiveness of tinzaparin sodium in the
). This correlates with the study by Brenner B. et al., where
Clinical and Experimental Obstetrics
007;14:143-145. doi: 10.1007/s00404-007-0527.
the use of enoxaparin in pregnancy has been seen to have safe
considering maternal and fetal outcome (22).
. Fawzy M, Shokeir T, Tatongy ML, et al. Treatment options
and pregnancy outcome in women with idiopathic recurrent
randomized placebo-controlled study.
In this randomized controlled trial study, enoxaparin given
at the daily dose of 40 mg (subcutaneous) did not improve the
chance of a live birth in non-thrombophilic women with
unexplained recurrent miscarriage. Therefore, we can
conclude that prophylactic doses of LMWH do not improve
the chance of a live birth in non-thrombophilic women with
unexplained recurrent miscarriage and should consequently no
longer be routinely prescribed in clinical practice.
Archives of Gynecology and Obstetrics. 2008;278:33-38.
. Dolitzky M, Inbal A, Segal Y, et al. A randomized study of
thromboprophylaxis in women with unexplained consecutive
recurrent miscarriages. Fertility and Sterility. 2006;86:326-
. Badawy AM, Khıary M, Sherif L, et al. Low-molecular
weight heparin in patients with recurrent early miscarriages
of unknown aetiology. Journal of Obstetrics and
. Van Horn, JT, Craven C, Ward K, et al. Histologic features
of placentas and abortion specimens from women with
antiphospholipid and antiphospholipid like syndromes.
The sample size was not determined prior at the beginning
of the study to reach a proper power. The number of patients
in each group was arbitrarily chosen however comparable to
the previous studies. The treatment groups were also not a
randomly assigned. So the potential biases were not excluded
including; selection bias and close follow-up of patients who
have been under the active treatment arm.
0. Di Simone N, Ferrazzani S, Castellani R, et al. Heparin and
low-dose aspirin restore placental human chorionic
gonadotrophin secretion abolished by antiphospholipid
Authors are aware of, and comply with, best practice in
publication ethics specifically with regard to authorship
1. Walport MJ. Complement. New England Journal of
2. Brenner B. Inherited thrombophilia and pregnancy loss.
avoidance of guest authorship), dual submission, manipulation
of figures, competing interests and compliance with policies on
research ethics. Authors adhere to publication requirements
that submitted work is original and has not been published
elsewhere in any language.
3. Kaandorp SP, Goddijn M, van der Post JA, et al. Aspirin
plus heparin or aspirin alone in women with recurrent
miscarriage. New England Journal of Medicine.
The authors declare that there is no conflict of interest that
would prejudice the impartiality of this scientific work.
14. Clark P, Walker ID, Langhorne P, et al. SPIN (Scottish
Pregnancy Intervention) study: a multicenter, randomized
controlled trial of low molecular-weight heparin and low-
dose aspirin in women with recurrent miscarriage. Blood.