Prevention of pre-eclampsia in high risk women with renal disease: A prospective randomized trial of heparin and dipyridamole

Summary: Twenty-one women with primary glomerulonephritis and a history of a poor outcome in previous pregnancies were randomized to receive heparin, 15 000 units subcutaneously and dipyridamole, 400 mg daily ( n = 10) or no treatment ( n = 11) from 14 weeks of gestation. the women were well matched in terms of the type of underlying glomerulonephritis and previous pregnancy complications. the treated group showed a significantly lower incidence of hypertension ( P <0.03) and of overall maternal complication ( P <0.03). the days spent in hospital prior to delivery were 18 in the treated group and 27 in the control group ( P <0.01). In all other parameters which were measured the outcome was better in the treated group although these did not achieve statistical signficance. In the control group the pregnancy complications were similar to those in previous pregnancies but very few complications occurred in treated patients. Heparin and dipyridamole were used because of the activation of coagulation in preeclampsia and because of the prominence of fibrin in renal and uterine vessels in pre-eclampsia. As heparin suppresses both the action and the production of endothelin, the benefit of treatment could have reflected endothelin inhibition.