Asprin, LMWH fail to improve recurrent miscarriage rate

Stef Kaandorp, MD

New Orleans— The ALIFE study found no improvement in live birth rate for women with unexplained recurrent miscarriage who took aspirin and nadroparin compared to aspirin alone or placebo. The findings were reported by Stef Kaandorp, MD, from the Academic Medical Center, Amsterdam, The Netherlands, at the 51st Annual Meeting of the American Society of Hematology, which took place December 5-8, 2009.

Recurrent miscarriages are experienced by 1%-3% of women, 50% of which are unexplained. These women desperately seek treatment to help them have a baby . Their doctors frequently prescribe aspirin and/or low-molecular-weight heparin based on the presumption that there are etiological similarities between unexplained recurrent miscarriage and antiphospholipid syndrome.

The ALIFE study was a multicenter randomized placebo-controlled trial designed to provide proof of whether or not these drugs increased the likelihood that a woman who experienced 2-3 unexplained miscarriages would give birth to a live child.

Investigators gave the combination of aspirin and low-molecular-weight heparin to 123 women, aspirin to 120 women, and placebo to 121 women. Live birthrates were 67 (54.5%) in the combination group, 61 (50.8%) in the aspirin group, and 69 (57%) in the placebo group.

In the aspirin and low-molecular-weight heparin group, 97 women became pregnant and 69.1% of them experienced live birth. Ninety-nine women in the aspirin group became pregnant and 61.1% of them experienced live birth compared to 103 pregnancies  and 67% live births in the placebo group.

The ALIFE study showed no statistically significant difference among any of the 3 treatment arms. While physicians have a strong urge to help their patients, Dr Kaandorp stated that armed with this knowledge, physicians should not recommend these treatments.

When asked about other treatments available to women experiencing recurrent miscarriages, Dr Kaandorp had no clear answer, but did state that they were not sitting still in the search for new ways to help these women have children.