Immunothrombosis-Related Recurrent Spontaneous Abortion: Mechanisms and Traditional Chinese Medicine Intervention

Abstract

Recurrent spontaneous abortion (RSA) is a perplexing condition affecting couples of reproductive age, with a complex etiology and approximately half of cases remaining unexplained. Recent studies have revealed that the pathogenesis of RSA is not simply isolated immune dysregulation or a prethrombotic state, but rather a deeply intertwined pathological process involving both systems. The concept of “immunothrombosis” provides a novel framework for understanding this coupled mechanism. This review systematically summarizes the mechanisms underlying immunothrombosis in RSA, including immune cell imbalance at the maternal-fetal interface (dNK cells, dMφ, Treg/Th17 imbalance), excessive complement activation, neutrophil extracellular trap (NET) release, anti-β2GPI antibody-mediated immunopathology, and the pivotal role of core signaling pathways such as TLR4/NF-κB. On this basis, we explore the scientific alignment between the traditional Chinese medicine (TCM) pathogenesis of “intertwined heat and blood stasis” and the immunothrombosis theory, and summarize the research progress on TCM herbs and formulas with dual “heat-clearing and blood-activating” effects in intervening in immunothrombosis. Finally, in view of the limitations of current research, we propose that future studies should focus on key pathological links of immunothrombosis and systematically validate the synergistic blocking effects and mechanisms of TCM herbs and formulas with “heat-clearing and blood-activating” properties on the vicious cycle of immune activation and coagulation, thereby providing new insights for the precise prevention and treatment of RSA with TCM.