Inherited thrombophilia and recurrent miscarriage: is there a role for anticoagulation during pregnancy?

A 32-year-old woman was referred to you at 15 weeks gestation regarding anticoagulation management. She has a history of 2 prior miscarriages at weeks 12 and 15, and she reports that she has a homozygous prothrombin gene mutation (PGM). She denies any personal or family history of venous thromboembolism. How would you approach anticoagulation in this patient?

Recurrent pregnancy loss (RPL) affects 1%-5% of couples, placing a significant psychological and physical burden on women and families and increasing health care costs. The etiology for RPL remains unexplained in half of the cases despite extensive evaluation, and physicians and patients resort to treatment modalities that have uncertain benefit in an attempt to achieve...