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Summary: In a retrospective cohort study of women with renal disease in pregnancy we investigated if:

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    low dose aspirin reduced die prevalence of preeclampsia and improved fetal outcome compared to no anticoagulant therapy.
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    heparin plus low dose aspirin and/or dipyridamole reduced die prevalence of preeclampsia and improved fetal outcome compared to i. no treatment ii. low dose aspirin alone.

Women with renal disease were allocated into 3 groups according to the treatment received during their pregnancies: I. no prophylactic heparin or antiplatelet drags, n=76 II. prophylactic low-dose aspirin 75(50–150)mg, n=27 III. prophylactic subcutaneous heparin 10,000 (5000-12,500) IU b.d. combined witii low-dose aspirin 50 (50–150)mg and/or dipyridamole 400 (200–400)mg, n=44. Preeclampsia and fetal outcome was analysed according to treatment group.

Preeclampsia was less common in the heparin group (2.3%) compared with 27.6% in the no treatment group [O.R. 0.06 (0.01-0.30)] and 25.9% in the aspirin group [O.R. 0.07 (0.01-0.38)].Women on aspirin, who developed preeclampsia, delivered later in pregnancy [35.4 (33–38.2) weeks] than preeclamptic women on no treatment [29 (22–38) weeks], p=0.04. There was a trend to reduced perinatal deatfis in the heparin + antiplatelet drug group, [2.3%; O.R., 0.17 (0.02-1.4)] and in the aspirin group [0%, O.R., 0.13 (0.01–2.3)] compared with 11.7% perinatal deaths in the no treatment group.

Heparin widi anti-platelet drugs may prevent preeclampsia in high risk women witfi renal disease. Further investigation in a randomized trial is indicated.