Loading...
Among women of reproductive age, about 5% of those who try to conceive experience two or more miscarriages; in about half of such women, no obvious cause is identified. Because miscarriages are common in women with inherited disorders associated with increased clotting, unrecognized clotting disorders have been postulated to be a cause for unexplained recurrent miscarriage. This theory has led some clinicians to administer antithrombotic therapy to women with unexplained recurrent miscarriage; however, reliable supportive data for this practice are lacking.
Dutch investigators randomly assigned 364 women (age range, 18–42) who had histories of two or more unexplained miscarriages and who were attempting to conceive or were pregnant (≤6 weeks' gestation) to receive daily treatment with low-dose aspirin (80 mg) plus low-molecular–weight heparin (subcutaneous nadroparin, 2850 IU), aspirin alone, or placebo. In all, 299 (82%) became pregnant and 197 (54% overall and 66% of those who became pregnant) had live births. Live-birth rates were similar among the three study groups. Post hoc analysis of adherent participants yielded similar results as did intention-to-treat analysis. Injection-site reactions and bruising occurred in almost half the women who received combined therapy. The trial was halted early on the basis of futility.
Kaandorp SP et al. Aspirin plus heparin or aspirin alone in women with recurrent miscarriage. N Engl J Med 2010 Apr 29; 362:1586.
Greer IA. Antithrombotic therapy for recurrent miscarriage? N Engl J Med 2010 Apr 29; 362:1630.
Comment
As an editorialist notes, this study provides good evidence that antithrombotic therapy should not be advocated for unexplained recurrent miscarriage. Although many options are available for managing early pregnancy loss (JW Womens Health Apr 1 2010), the deeply disturbing problem of recurrent loss has no solution at this point; thus, we must continue merely to support affected couples as they attempt to have children.