Early pregravid correction of hemostasis assessed by novel biomarkers improves the outcomes of pregnancies in women with bad obstetric history

Premorbid hypercoagulability causes obstetric complications; therefore, anticoagulation from the preconception period and throughout pregnancy may be beneficial in cases of bad obstetric history(BOH). The aim of the study is to test this hypothesis, 115 patients with BOH and 38 healthy women without prior obstetric complications were examined. Patients with antiphospholipid syndrome were excluded, and the groups were matched based on the frequency of congenital thrombophilia. Hemostasis was assessed before and during pregnancy using the Thrombodynamics assay and routine coagulation tests. Platelet function was characterized using a blood clot contraction assay and flow cytometry. All patients with BOH received enoxaparin(low molecular weight heparin, LMWH) starting from the preconception period and aspirin after the 10th week of pregnancy. Doses were adjusted based on dynamic laboratory monitoring. In women with BOH, premorbid hypercoagulability was associated with platelet dysfunction due to chronic activation and exhaustion. With enoxaparin and aspirin treatment before and during pregnancy, hemostasis and platelet function improved progressively. By the second trimester, these parameters were comparable to normal levels. In patients with BOH receiving enoxaparin and aspirin, pregnancy outcomes were significantly more favorable compared to previous pregnancies. No hemorrhagic complications were observed. For women with BOH, the early and controlled use of LMWH starting from the preconception period, along with aspirin from the 10th through the 34th week of pregnancy, improves hemostasis, prevents obstetric complications, and significantly increases the likelihood of a favorable pregnancy outcome. These results were achieved through dynamic laboratory monitoring using novel hemostatic assays and platelet contractility as biomarkers.