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

Abstract

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.

Keywords: D-dimer; antiphospholipid syndrome; low molecular weight heparin; low-dose aspirin; recurrent pregnancy loss.