Aspirin Does Not Improve Live Birth Rate in Women With Recurrent Miscarriage

December 08, 2009

By Anthony J. Brown, MD

NEW YORK (Reuters Health) Dec 07 - The use of aspirin alone or combined with nadroparin, a low-molecular-weight heparin, does not increase the live birth rate in women with unexplained recurrent miscarriage, according to study findings presented this week at the 51st annual meeting of the American Society of Hematology in New Orleans.

"Women with unexplained recurrent miscarriage should not be prescribed low-molecular-weight heparin and/or aspirin since they will not benefit from this treatment," lead researcher Dr. Stef P. Kaandorp, from the Academic Medical Center in Amsterdam, told Reuters Health.

Aspirin and low-molecular weight heparins are increasingly being used to treat unexplained recurrent miscarriage, but data to support this practice are lacking.

To determine if these treatments offer a benefit, Dr. Kaandorp's group conducted the randomized, controlled ALIFE trial at eight centers in the Netherlands. Women were eligible if they were between 18 and 42 years old, diagnosed with unexplained recurrent miscarriage (two or more miscarriages with an upper gestational age of 20 weeks), and attempting to conceive or less than 6 weeks pregnant.

Between 2004 and 2008, participants were randomly assigned to receive aspirin, aspirin plus nadroparin, or placebo. The current interim analysis included 281 women who had either a live birth or miscarriage by July 1, 2009.

The live birth rates in the aspirin and aspirin/nadroparin groups were 67.4% and 71.4%, respectively, comparable with the 70.5% rate seen in the placebo group.

So should these agents be abandoned as a treatment for all women with recurrent miscarriage? Not necessarily, according to Dr. Kaandorp, who said, "Our study was not large enough to investigate whether specific subgroups benefit from aspirin combined with low-molecular-weight heparin or aspirin alone."

In particular, Dr. Kaandorp noted, "A future study should assess whether low-molecular-weight heparin improves the chance of a live birth in women with recurrent miscarriage and inherited thrombophilia and should again include a no-treatment or placebo-control group."

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