Anticoagulants and Recurrent Pregnancy Loss

In some instances, recurrent pregnancy loss (i.e., 2 or more miscarriages) is thought to be due to thrombosis of placental blood vessels. In patients with antiphospholipid antibody syndrome (APS) — a thrombotic disorder — administration of aspirin or low-molecular-weight heparin (LMWH) seems to lower risk for pregnancy loss. Does anticoagulant therapy prevent miscarriages in women without APS? To address this question, Dutch investigators conducted a randomized trial of low-dose aspirin (80 mg daily) combined with LMWH (subcutaneous nadroparin, 2850 IU daily), aspirin alone, or placebo in 364 women (mean age, 34) with unexplained recurrent pregnancy loss (median number of past miscarriages, 3). Therapy was initiated at <6 weeks' gestation a…