PMID- 24040195
OWN - NLM
STAT- MEDLINE
DCOM- 20140603
LR  - 20211021
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 8
IP  - 9
DP  - 2013
TI  - Aspirin and low-molecular weight heparin combination therapy effectively prevents 
      recurrent miscarriage in hyperhomocysteinemic women.
PG  - e74155
LID - 10.1371/journal.pone.0074155 [doi]
LID - e74155
AB  - The management of recurrent pregnancy loss (RPL) still remains a great challenge, 
      and women with polycystic ovarian syndrome (PCOS) are at a greater risk for 
      spontaneous abortion. Treatment with low-molecular-weight heparin (LMWH) has 
      become an accepted treatment option for women with RPL; however, the subgroup of 
      women, who are likely to respond to LMWH, has not been precisely identified. The 
      present study evaluated the efficacy of LMWH with reference to PCOS and 
      associated metabolic phenotypes including hyperhomocysteinemia (HHcy), insulin 
      resistance (IR) and obesity. This prospective observational study was conducted 
      at Institute of Reproductive Medicine, Kolkata, India. A total of 967 women with 
      history of 2 or more consecutive first trimester abortions were screened and 336 
      were selected for the study. The selected patients were initially divided on the 
      basis of presence or absence of PCOS, while subsequent stratification was based 
      on HHcy, IR and/or obesity. The subjects had treatment with aspirin during one 
      conception cycle and aspirin-LMWH combined anticoagulant therapy for the 
      immediate next conception cycle, if the first treated cycle was unsuccessful. 
      Pregnancy salvage was the sole outcome measure. The overall rate of pregnancy 
      salvage following aspirin therapy was 43.15%, which was mostly represented by 
      normohomocysteinemic women, while the salvage rate was lower in the HHcy 
      populations irrespective of the presence or absence of PCOS, IR, or obesity. By 
      contrast, aspirin-LMWH combined therapy could rescue 66.84% pregnancies in the 
      aspirin-failed cases. Logistic regression analyses showed that HHcy remained a 
      significant factor in predicting salvage rates in the PCOS, IR, and obese 
      subpopulations controlled for other confounding factors. With regard to pregnancy 
      salvage, combined anticoagulant therapy with aspirin and LMWH conferred added 
      benefit to those with HHcy phenotype.
FAU - Chakraborty, Pratip
AU  - Chakraborty P
AD  - Department of Infertility, Institute of Reproductive Medicine, Salt Lake City, 
      Kolkata, West Bengal, India.
FAU - Banerjee, Sayani
AU  - Banerjee S
FAU - Saha, Piyali
AU  - Saha P
FAU - Nandi, Shyam Sundar
AU  - Nandi SS
FAU - Sharma, Sunita
AU  - Sharma S
FAU - Goswami, Sourendra K
AU  - Goswami SK
FAU - Chakravarty, Baidyanath
AU  - Chakravarty B
FAU - Kabir, Syed N
AU  - Kabir SN
LA  - eng
PT  - Journal Article
DEP - 20130905
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
MH  - Abortion, Habitual/*drug therapy/pathology
MH  - Adult
MH  - Anticoagulants/*therapeutic use
MH  - Aspirin/*therapeutic use
MH  - Drug Therapy, Combination
MH  - Female
MH  - Heparin, Low-Molecular-Weight/*therapeutic use
MH  - Humans
MH  - Hyperhomocysteinemia/complications/*drug therapy/pathology
MH  - Insulin Resistance
MH  - Live Birth
MH  - Obesity/complications/*drug therapy/pathology
MH  - Polycystic Ovary Syndrome/complications/*drug therapy/pathology
MH  - Pregnancy
MH  - Prospective Studies
MH  - Risk Factors
MH  - Treatment Outcome
PMC - PMC3764119
COIS- Competing Interests: The authors have declared that no competing interests exist.
EDAT- 2013/09/17 06:00
MHDA- 2014/06/04 06:00
PMCR- 2013/09/05
CRDT- 2013/09/17 06:00
PHST- 2013/03/22 00:00 [received]
PHST- 2013/07/29 00:00 [accepted]
PHST- 2013/09/17 06:00 [entrez]
PHST- 2013/09/17 06:00 [pubmed]
PHST- 2014/06/04 06:00 [medline]
PHST- 2013/09/05 00:00 [pmc-release]
AID - PONE-D-13-13240 [pii]
AID - 10.1371/journal.pone.0074155 [doi]
PST - epublish
SO  - PLoS One. 2013 Sep 5;8(9):e74155. doi: 10.1371/journal.pone.0074155. eCollection 
      2013.