ASH: Data Do Not Support Anticoagulation to Prevent Recurrent iscarriage

NW ORLANS — A randomized trial that compared anticoagulation regimens among women with a history of unexplained miscarriage found no value in any of the strategies, researchers here reported

A randomized trial that compared three anticoagulation strategies — low molecular weight heparin plus aspirin, aspirin, and placebo — found that about two-thirds of the women in each group delivered a healthy child, said Stef Kaandorp, D, a research fellow in obstetrics and gynecology at the University of Amsterdam

Kaandrop discussed the results at a press briefing at the American Society of Hematology meeting here

“About 1% to 3% of women have recurrent miscarriage, and about 50% of the reasons for those miscarriages are unexplained,” he said “Because many of these women are desperate to have children, their physicians will often ‘do something’ and that includes offering anticoagulation therapy”

However, with the results of his trial in hand, Kaandorp said, “it now would not be proper for doctors to prescribe aspirin or low molecular weight heparin to these women”

In his trial, Kaandorp and colleagues recruited 364 women who had a history of unexplained recurrent miscarriage and assigned them to one of three groups: aspirin and low molecular weight heparin nadroparin, aspirin alone, or placebo

Those on placebo or aspirin were blinded to their treatment Those receiving subcutaneous nadroparin were aware of their treatment assignment

Among the findings:

Sixty-seven of the 97 women in the low molecular weight heparin group who became pregnant delivered a healthy child — a live birth rate of 691% Sixty-one of the 99 women in the aspirin group who became pregnant delivered a healthy child — a live birth rate of 611% Sixty-nine of 103 women in the placebo group who became pregnant delivered a healthy child for a live birth rate of 670%

In none of the scenarios was there any statistically significant difference, Kaandorp said

The treatment didn’t come without some cost in side effects, said Saskia iddeldorp, D, associate professor of vascular medicine at the University of Leiden, the Netherlands, and the senior author of the study “Half the women on anticoagulant therapy reported bruising, and 40% of the women treated with low molecular weight heparin reported injection site pain and reactions,” she said

“This treatment should not be done,” said Harry Buller, D, PhD, professor of medicine at the Academic edical enter, Amsterdam, another co-author of the study

Kaandorp said recruiting patients for the study was a struggle because many of the physicians asked to participate were already treating their patients with anticoagulation therapies

He and colleagues in the US said that because the therapy was widespread in America the study patients probably would not be accrued here

“There is a presumed etiologic similarities between unexplained recurrent miscarriage and antiphospholipid syndrome,” Kaandorp said “In women with recurrent miscarriage and antiphospholipid syndrome, treatment with heparin and aspirin appears to improve pregnancy outcome”

Buller also noted that there may be some belief that thrombosis in small blood vessels may be part of the problem with recurrent miscarriage

But Kaandorp said his trial indicated “these treatments should not be recommended Aspirin and nadroparin and aspirin alone do not improve the chance of a live birth in women with unexplained recurrent miscarriage”

Kaandorp reported no relevant disclosures

iddeldorp and Buller disclosed financial relationships with GlaxoSmithKline

source : www.medpagetoday.com

Related News:

Details :
Submited at Monday, December 14th, 2009 at 7:41 pm on Obstetrics & Gynaecology by ethan
Comment RSS 2.0 - leave a comment - trackback

Leave Comment Here...