Cited by 1,113Systemic Lupus Erythematosus ResearchReproductive System and PregnancyBlood Coagulation and Thrombosis Mechanisms

Randomised controlled trial of aspirin and aspirin plus heparin in pregnant women with recurrent miscarriage associated with phospholipid antibodies (or antiphospholipid antibodies)

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Rai, R, Cohen, H, Dave, M, Regan, L·1997·BMJ

Abstract

Objective To determine whether treatment with low dose aspirin and heparin leads to a higher rate of live births than that achieved with low dose aspirin alone in women with a history of recurrent miscarriage associated with phospholipid antibodies (or antiphospholipid antibodies), lupus anticoagulant, and cardiolipin antibodies (or anticardiolipin antibodies). Design Randomised controlled trial. Setting Specialist clinic for recurrent miscarriages. Subjects 90 women (median age 33 (range 22-43)) with a history of recurrent miscarriage (median number 4 (range 3-15)) and persistently positive results for phospholipid antibodies. Intervention Either low dose aspirin (75 mg daily) or low dose aspirin and 5000 U of unfractionated heparin subcutaneously 12 hourly. All women started treatment with low dose aspirin when they had a positive urine pregnancy test. Women were randomly allocated an intervention when fetal heart activity was seen on ultrasonography. Treatment was stopped at the time of miscarriage or at 34 weeks' gestation. Main outcome measures Rate of live births with the two treatments. Results There was no significant difference in the two groups in age or the number and gestation of previous miscarriages. The rate of live births with low dose aspirin and heparin was 71% (32/45 pregnancies) and 42% (19/45 pregnancies) with low dose aspirin alone (odds ratio 3.37 (95% confidence interval 1.40 to 8.10)). More than 90% of miscarriages occurred in the first trimester. The…

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Crossref · 10.1136/bmj.314.7076.253

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  • Pooled data from one RCT in women with first-trimester losses and eight observational studies not exclusively early losses indicated higher likelihood of live births with LDA plus prophylactic heparin versus LDA alone.

    “Pooled data from one RCT including only patients with a history of first trimester losses46 and eight supporting observational studies47–54 that did not exclusively study women with early pregnancy losses indicated a higher likelihood of live births with combination treatment with LDA and heparin at prophylactic dosage versus LDA alone.”

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Authors
Rai, R., Cohen, H., Dave, M., & Regan, L.
Affiliations
Imperial College London (GB)
Corresponding author
Regan, L
Venue
BMJ
Publisher
BMJ
Published
1997-01-25
Volume
314
Issue
7076
Pages
253
ISSN
  • 0007-1447 (ISSN-L)
  • 0959-8138
  • 1468-5833
OpenAlex
W2061071054
Cited by
1,113
References
2
Citations by year
2026: 10 · 2025: 9 · 2024: 14 · 2023: 12 · 2022: 15 · 2021: 18 · 2020: 46 · 2019: 23 · 2018: 22 · 2017: 30 · 2016: 52 · 2015: 28 · 2014: 42 · 2013: 38 · 2012: 45
FWCI
28.48
Type
journal article
Language
en
Open access
Locations
  • BMJ (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Funders
Medical Research Council
Topics
  • Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
  • Life Sciences › Immunology and Microbiology › Immunology › Reproductive System and Pregnancy
  • Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
Keywords
recurrent pregnancy loss, antiphospholipid antibodies, low-dose aspirin, unfractionated heparin, live birth rate, lupus anticoagulant, anticardiolipin antibodies, pregnancy outcomes, bone mineral density, first-trimester miscarriage, anticoagulation in pregnancy
MeSH terms
Abortion, Habitual, Adult, Aspirin, Female, Fibrinolytic Agents, Heparin, Humans, Immunoglobulin G, Pregnancy, Pregnancy Complications, Pregnancy Outcome, Antiphospholipid Syndrome, Antibodies, Anticardiolipin

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