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Dalteparin for the prevention of recurrence of placental-mediated complications of pregnancy in women without thrombophilia: a pilot randomized controlled trial.

Author(s): Rey E, Garneau P, David M, Gauthier R, Leduc L, Michon N, Morin F, Demers C, Kahn SR, Magee LA, Rodger M

Affiliation(s): Division of Obstetrics Medicine, Department of Obstetrics and Gynaecology, CHU Sainte-Justine, Montreal, QC, Canada. evelyne_rey@ssss.gouv.qc.ca

Publication date & source: 2009-01, J Thromb Haemost., 7(1):58-64. Epub 2008 Nov 20.

Publication type: Research Support, Non-U.S. Gov't

BACKGROUND: The role of anticoagulants for the prevention of placental-mediated pregnancy complications is uncertain. OBJECTIVES: Our aim was to investigate the effectiveness of dalteparin, a low-molecular-weight heparin, in preventing the recurrence of these complications in women without thrombophilia. PATIENTS/METHODS: Between August 1 2000 and June 20 2007, 116 pregnant women with: (i) <or= 16 weeks' gestation, (ii) no detectable thrombophilia, (iii) previous severe pre-eclampsia, newborn weight <or= 5th percentile, unexplained intrauterine death or abruptio placentae were randomized to either a prophylactic daily dose of dalteparin (n = 58) or no dalteparin (n = 58). The primary outcome was a composite of one or more of: severe pre-eclampsia, newborn weight <or= 5th percentile or major abruptio placentae. Secondary outcomes included non-severe pre-eclampsia, newborn weight at the 6-10th percentile and gestational age at delivery. Analyses were by intention to treat. P < 0.05 was considered to be significant. This study is registered as an International Standard Randomized Controlled Trial, number ISRCTN78732833. RESULTS: Among the 110 women included in the final analysis, dalteparin was associated with a lower rate of the primary outcome [5.5% (n = 3/55) vs. 23.6% (n = 13/55), adjusted odds ratio (OR) 0.15, 95% confidence interval (CI) 0.03-0.70]. Secondary outcomes were not statistically different between the groups. Bleeding problems or thrombocytopenia did not occur. CONCLUSION: In this pilot study, dalteparin is effective in decreasing the recurrence of placental-mediated complications in women without thrombophilia. Our results require confirmation in further randomized trials.

Page last updated: 2009-02-08

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