CLINICAL EFFICACY OF THROMBOPHILIA SCREENING AND ANTICOAGULANT INTERVENTION IN REDUCING RECURRENT PREGNANCY LOSS AMONG HIGH-RISK POPULATIONS

Dr. Priya Sharma; MD; Prof. Arjun Reddy; MD; DM

Abstract

Recurrent pregnancy loss (RPL) remains a significant clinical challenge, affecting approximately 1-3% of couples. While the etiology is multifactorial, the role of inherited and acquired thrombophilias in placental insufficiency and subsequent fetal demise is a focal point of contemporary obstetric research. This study evaluates the prevalence of specific thrombophilic markers—including Factor V Leiden, Prothrombin G20210A, and Antiphospholipid Antibodies (aPL)—within a large cohort of patients experiencing three or more consecutive losses. Furthermore, the investigation assesses the efficacy of low-molecular-weight heparin (LMWH) combined with low-dose aspirin (LDA) versus conventional care. By correlating genetic predispositions with clinical pregnancy outcomes, this abstract provides a comprehensive overview of the diagnostic utility of screening and the therapeutic impact of anticoagulant intervention. The findings suggest that while universal screening remains controversial, targeted testing in the presence of specific risk factors significantly improves live birth rates. This research contributes to the standardization of RPL management protocols, emphasizing the transition toward personalized reproductive immunology and hematology. Ultimately, the data underscores a critical window for intervention in thrombophilia-positive patients to mitigate adverse gestational outcomes.

Keywords: Recurrent Pregnancy Loss, Thrombophilia Screening, Factor V Leiden, Low-Molecular-Weight Heparin, Antiphospholipid Syndrome, Obstetric Outcomes, Live Birth Rate, Anticoagulation Therapy

The management of recurrent pregnancy loss (RPL) is a cornerstone of reproductive medicine, yet the utility of thrombophilia screening remains one of the most debated topics in the field. This research is highly relevant to AAMS conference delegates as it addresses the gap between clinical guidelines and real-world hematologic interventions. By providing robust quantitative evidence on the success rates of LMWH/LDA regimens, this study assists clinicians in making evidence-based decisions regarding the necessity of expensive genetic testing. Furthermore, with the rising age of conception and the increasing prevalence of metabolic risk factors, understanding the vascular components of pregnancy maintenance is essential. This work aligns with the global shift toward precision medicine, ensuring that anticoagulant therapies are reserved for those with the highest likelihood of benefit, thereby minimizing unnecessary medicalization and potential side effects in low-risk populations. It provides a blueprint for improving maternal reproductive health through targeted diagnostic and therapeutic excellence.

To evaluate the prevalence of thrombophilic mutations in patients with recurrent pregnancy loss and to determine the clinical efficacy of combined LMWH and aspirin therapy in improving live birth rates among this cohort.

A prospective longitudinal study was conducted involving 850 women with a history of three or more consecutive pregnancy losses before 20 weeks of gestation. Participants underwent comprehensive thrombophilia screening, including Factor V Leiden (FVL), Prothrombin G20210A mutation, Protein C and S deficiency, and Antiphospholipid Syndrome (APS) markers (Lupus anticoagulant, Anti-cardiolipin, and Anti-β2-glycoprotein I antibodies). The cohort was stratified into a Thrombophilia Group (n=312) and an Unexplained RPL Group (n=538). The Thrombophilia Group was further divided into an intervention arm receiving LMWH (Enoxaparin 40mg/day) plus LDA (75mg/day) from the confirmation of pregnancy, and a control arm receiving standard prenatal care. Primary outcomes were defined as the live birth rate (LBR) and the incidence of late-gestation complications such as preeclampsia and placental abruption. Statistical analysis utilized Chi-square tests and logistic regression to calculate Odds Ratios (OR) with 95% Confidence Intervals (CI), with p < 0.05 considered significant.

Among the 850 participants, 36.7% (n=312) tested positive for at least one thrombophilic marker. The most prevalent markers were FVL (14.2%) and APS (12.4%). In the Thrombophilia Group, the intervention arm (LMWH+LDA) demonstrated a significantly higher live birth rate of 78.4% compared to 42.1% in the control arm (OR 5.02; 95% CI 3.12–8.09; p < 0.001). For women with FVL specifically, the LBR rose from 35% without treatment to 81% with intervention. In contrast, for the Unexplained RPL Group, the administration of LMWH showed a non-significant improvement in LBR (64.2% vs 61.5%; p = 0.48). Late-gestation complications, including severe preeclampsia, were significantly lower in the treated thrombophilia group (5.2% vs 16.8%; p = 0.004). Minimal adverse effects were reported, with local injection site reactions being the most common (12%). No significant increase in major maternal hemorrhage was observed (p = 0.72).

The study confirms a significant association between both inherited and acquired thrombophilias and recurrent pregnancy loss. Screening for Factor V Leiden and Antiphospholipid Syndrome should be prioritized in the diagnostic workup. Crucially, the administration of LMWH combined with LDA proved highly effective in increasing the live birth rate for thrombophilia-positive women, whereas its benefit in unexplained RPL remains marginal. These findings advocate for a stratified approach to RPL management, where antithrombotic therapy is tailored to the patient’s specific hematologic profile. Implementing standardized screening protocols can significantly reduce the incidence of subsequent miscarriages, optimizing maternal-fetal outcomes and providing a clear clinical pathway for high-risk reproductive cases. Future research should focus on the cost-effectiveness of early-gestation screening in primary care settings.