Obstetrics, Gynecology and Reproduction

Advanced search

Advisory Board conclusion following the discussion "Controversial issues of low molecular weight heparins use in obstetrics"

Full Text:


Antithrombotic therapy is often used during pregnancy for the treatment and prevention of venous thromboembolism, systemic embolism in patients with heart valve prostheses, for prevention of foetal loss in patients with antiphospholipid syndrome, placenta-mediated complications. In common, low molecular weight heparins (LMWHs) have largely replaced unfractionated heparin as the anticoagulant. However, in case of placenta-mediated complications it has off-label status. The effectiveness and safety of the LMWHs in pregnant women at an increased risk of placenta-mediated complications is discussed in this review. LMWH is effective, safety, easy to administer and associated with a low incidence of foetal and maternal complications.

About the Author

article Editorial

Russian Federation


1. Cartwright J.E., Fraser R., Leslie K. et al. Remodelling at the maternal-fetal interface: relevance to human pregnancy disorders. Reproduction. 2010;140(6):803-13.

2. Helmo F.R., Lopes A.M., Carneiro A.C. et al. Angiogenic and antiangiogenic factors in preeclampsia. Pathol Res Pract. 2018;214(1):7-14.

3. Yinon Y., Ben Meir E., Margolis L. et al. Low molecular weight heparin therapy during pregnancy is associated with elevated circulatory levels of placental growth factor. Placenta. 2015;36(2):121-4.

4. Rodger M.A., Gris J.-C., de Vries J.I.P. et al; Low-Molecular-Weight Heparin for Placenta-Mediated Pregnancy Complications Study Group. Low-molecular-weight heparin and recurrent placenta-mediated pregnancy complications: a meta-analysis of individual patient data from randomised controlled trials. Lancet. 2016;388(10060):2629-41.

5. Cho N.H., Shaw J.E., Karuranga S. et al. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018;138:271-81.

6. Wang B., Aw T.Y., Stokes K.Y. N-acetylcysteine attenuates systemic platelet activation and cerebral vessel thrombosis in diabetes. Redox Biol. 2018;14:218-28.

7. Chung W.S., Lin C.L., Kao C.H. Diabetes increases the risk of deep-vein thrombosis and pulmonary embolism. A population-based cohort study. Thromb Haemost. 2015;114(4):812-8.

8. Wang P.C., Chen T.H., Chung C.M. et al. The effect of deep vein thrombosis on major adverse limb events in diabetic patients: a nationwide retrospective cohort study. Sci Rep. 2021;11(1):8082.

9. ACOG Practice Bulletin No. 202: Gestational hypertension and preeclampsia. Obstet Gynecol. 2019;133:e1-25.

10. Shastri M.D., Stewart N., Eapen M. et al. Opposing effects of low molecular weight heparins on the Release of inflammatory cytokines from peripheral blood mononuclear cells of asthmatics. PLoS One. 2015;10(3):e0118798.

11. Zhang N., Zhan Y., Shi P. et al. LMWH inhibits TNF-a and IL-6 in placental villous explants and its effects are attenuated by TLR-4/NF-kB p65 blocking in JEG-3 cells. Int J Clin Exp Med. 2018;11:674-83.

12. Wat J.M., Hawrylyshyn K., Baczyk D. et al. Effects of glycol-split low molecular weight heparin on placental, endothelial, and anti-inflammatory pathways relevant to preeclampsia. Biol Reprod. 2018;99(5):1082-90.

13. McLaughlin K. et al. Low molecular weight heparin improves endothelial function in pregnant women at high risk of preeclampsia. Hypertension. 2017;69(1):180-8.

14. Yan Y., Ji Y., Su N. et al. Non-anticoagulant effects of low molecular weight heparins in inflammatory disorders: A review. Carbohydr Polym. 2017;160:71-81.

15. Yang C., Wu T., Huang C. Low molecular weight heparin reduces triglyceride, VLDL and cholesterol/HDL levels in hyperlipidemic diabetic patients on hemodialysis. Am J Nephrol. 1998;18(5):384-90.

16. Rodger M.A., Langlois N.J., de Vries J.I. et al. Low-molecular-weight heparin for prevention of placenta-mediated pregnancy complications: protocol for a systematic review and individual patient data meta-analysis (AFFIRM). Syst Rev. 2014;3:69.

17. Bujold E., Roberge S., Lacasse Y. et al. Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis. Obstet Gynecol. 2010;116(2 Pt 1):402-14.

18. Bouvier S., Fortier M., Vincent L. et al. NETosis markers in pregnancy: effects differ according to histone subtypes. Thromb Haemost. 2021;121(7):877-90.

19. Lindmark E., Siegbahn A. Tissue factor regulation and cytokine expression in monocyte-endothelial cell co-cultures: effects of a statin, an ACE-inhibitor and a low-molecular-weight heparin. Thromb Res. 2002;108(1):77-84.

20. Momot A.P., Nikolaeva M.G., Elykomov V.A., Momot K.A. The role of APC-resistance for predicting venous thrombosis and pregnancy complications in carriers of factor V Leiden (1691) G/A mutation. In: Pregnancy and Birth Outcomes. Groatia, 2018. 33-56.

21. Momot A.P., Nikolaeva M.G., Yasafova N.N. et al. Clinical and laboratory manifestations of the prothrombin gene mutation in women of reproductive age. J Blood Med. 2019;10:255-63.

22. Nikolaeva M.G., Momot A.P., Zainulina M.S. et al. Pregnancy complications in G20210A mutation carriers associated with high prothrombin activity. Thrombosis J. 2020;19:41.

23. Momot A.P., Nikolaeva M.G., Zainulina M.S. Effects of low-molecular heparin on pregnant women with factor V mutation (GA genotype). J Hematol Blood Transfus Disord. 2018;5:20.

24. Nikolaeva M.G., Vakhlova Zh.I. Gene thrombophilia carriers in Altai Krai. Software registration certificate №2020663009. 2020.


For citations:

Advisory Board conclusion following the discussion "Controversial issues of low molecular weight heparins use in obstetrics". Obstetrics, Gynecology and Reproduction. 2021;15(4):461-469. (In Russ.)

Views: 259

ISSN 2313-7347 (Print)
ISSN 2500-3194 (Online)