Authors' objectives:

The purpose of this report is to assess the evidence on the clinical usefulness of plasminogen activator inhibitor 4G/5G polymorphism testing in recurrent miscarriage.

Authors' results and conclusions: Seven trials whose aim was to demonstrate the association between the PAI-1 4G/5G polymorphism and recurrent miscarriage were found. All of them used the RFLP-PCR technique. Two showed no association and one did. In the other four, association was demonstrated if the homozygotic 4G/4G combined with polycystic ovarian syndrome (two studies), deletion of the angiotensin I-converting enzyme gene or coagulation factor XIII Val34Leu polymorphism. In the study that demonstrated the association between PAI 4G/5G polymorphism and recurrent miscarriages, this was greater if associated with methylenetetrahydrofolate reductase gene C677T polymorphism. Clinical practice guidelines: Guidelines for the management of recurrent miscarriages issued by the American College of Obstetricians and Gynecologists, the Royal College of Obstetricians and Gynecologist, the Argentine Society on Reproductive Medicine and the guidelines on antithrombotic agents use during pregnancy issued by the American College of Chest Physicians (Consensus Conference on Antithrombotic Therapy and Thrombolic Therapy) were consulted. None of them mentioned the need of performing plasminogen activator inhibitor 4G/5G polymorphism testing in recurrent miscarriage. Health technology evaluations: No health technology assessment was found among the sources consulted.

Authors' recommendations: There is not enough evidence to support the association between PAI 4G/5G polymorphism and recurrent miscarriage. The results obtained in the trials are inconsistent. Some studies suggest that the coexistence of homozygotic 4G/4G genotype with other factors that also raise PAI-1 plasma levels could be associated with a higher risk of miscarriage. On the other hand, there is no therapeutic intervention which has been specifically assessed for this subgroup of patients. As previously mentioned, there is not enough evidence to support plasminogen activator inhibitor 4G/5G polymorphism testing as part of the evaluation of patients with recurrent miscarriages.

Authors' methods: Overview

Project Status: Completed

URL for project: http://www.iecs.org.ar/

Year Published: 2006

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Argentina

Organisation Name: Institute for Clinical Effectiveness and Health Policy

Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA

Contact Name: info@iecs.org.ar

Contact Email: info@iecs.org.ar

Copyright: Institute for Clinical Effectiveness and Health Policy (IECS)