Use of D‐dimer measurement to guide anticoagulant treatment in recurrent pregnancy loss associated with antiphospholipid syndrome

摘要

Problem To examine whether the level of plasma D‐dimer can guide anticoagulant treatment in recurrent pregnancy loss ( RPL ) associated with antiphospholipid syndrome ( APS ). Methods A total of 1096 RPL women with APS between 2012 and 2015 in a single‐center hospital were randomly divided into two groups (group A, 75?mg of low‐dose aspirin [ LDA ] daily; group B, 75?mg of LDA plus 4100 U of low molecular weight heparin [ LMWH ] subcutaneously daily); 1015 of the total successfully completed the trial. Plasma D‐dimer level and live birth rates were estimated. Results For APS women with an elevated D‐dimer level at baseline, higher live birth rates were reached in LDA plus LMWH group compared to LDA alone group (92.71% vs 61.68%, P ??.0001); however, no significant differences were found between the two groups of women with a normal D‐dimer level (87.08% vs 83.76%, P ?=?.48). Women with a normal D‐dimer level at all blood draw points had the highest live birth rates (92.88%), as compared with those with persistently abnormal D‐dimer at all blood draw points or increased D‐dimer level after treatment ( P ??.001). Conclusion The combination therapy with LDA and LMWH is not essential for all APS women, but has proven to be beneficial for women with an elevated D‐dimer level.