Дальтепарин+аспирин снижают риск развития преэклампсии у беременных с тромбофилией

[Dr.Vad]

Дальтепарин с аспирином, назначенные на сроке до 12 недель беременности, более успешно снижают риск развития преэклампсии, ХЕЛЛП синдрома, эклампсии у беременных пациенток с врожденной тромбофилией (дефицит антикоагулянтных белков, гетерозоготы по фактору 5 лейден и протромбину) и предшествующим эпизодом пре/эклампсии до 34 недель по сравнению с аспирином: снижение риска на 8.7% (12 пролеченных чтобы предотвратить 1 эпизод)

J Thromb Haemost. 2011 Nov 25.
Low-Molecular-Weight Heparin Added to Aspirin in the Prevention of Recurrent Early-Onset Preeclampsia in women with Inheritable Thrombophilia: the FRUIT-RCT.
de Vries JI, van Pampus MG, Hague WM, Bezemer PD, Joosten JH; For FRUIT investigators.
Background: Early-onset hypertensive disorders of pregnancy (HD) and small-for-gestational age infants (SGA) are associated with placental vascular thrombosis, often recur and are also associated with inheritable thrombophilia. Aspirin reduces the recurrence risk. Objective: Adding low-molecular-weight heparin (LMWH) to aspirin at <12 weeks gestation reduces recurrence of HD in women with previous early-onset HD (preeclampsia, HELLP syndrome, eclampsia) and/or SGA, in the context of inheritable thrombophilia without antiphospholipid antibodies. Patients/Methods: In a multicenter RCT, 139 women were included <12 weeks gestation. Inclusion criteria: previous delivery <34 weeks gestation with HD and/or SGA; inheritable thrombophilia (protein C deficiency; protein S deficiency; activated protein C resistance; Factor V Leiden heterozygosity; prothrombin gene G20210A mutation heterozygosity); no antiphospholipid antibodies detected. Intervention: either daily LMWH (dalteparin, 5000 IU weight-adjusted dosage) with aspirin 80 mg or aspirin 80 mg alone. Main outcome measures: Primary outcomes: recurrent HD onset 1) <34 weeks gestation and 2) irrespective of gestational age. Secondary outcomes: recurrent SGA, preterm birth, maternal/neonatal hospitalization, spontaneous abortion, individual HD. Analysis by intention-to-treat. Results: LMWH with aspirin reduced recurrent HD onset <34 weeks gestation (risk difference (RD) 8.7%: CI of RD 1.9-15.5%; p=.012; NNT 12). Recurrent HD irrespective of gestational age was not different between arms. No women withdrew for adverse effects. Trial Registration: [Ссылки доступны только зарегистрированным пользователям ] (isrctn87325378). Conclusions: Adding LMWH to aspirin at <12 weeks gestation reduces recurrent HD onset <34 weeks gestation in women with inheritable thrombophilia and prior delivery for HD/SGA <34 weeks. Close monitoring of mother and fetus remains important throughout pregnancy.