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Overcoming Chronic Pregnancy Loss

Aspirin-heparin combo effective in preventing some miscarriages, study finds

THURSDAY, Jan. 3, 2002 (HealthDayNews) -- In an effort to end the continuing debate over the best way to prevent certain kinds of chronic miscarriage, new research claims one form of therapy works better than the rest.

The treatment involves aspirin, in combination with the blood thinner heparin. It's a powerful one-two punch, say the researchers, who hail from New Zealand, Australia and the United States. In women diagnosed with an autoimmune disorder known as antiphospholipid antibodies syndrome, where tiny blood clots form in the vessels leading from the mother to the baby, the study found the combination reduces the risk of miscarriage.

"The disease affects both the arterial system and the venous system," explains Dr. Charles Lockwood, chairman of obstetrics and gynecology at New York University's School of Medicine.

"The only way to prevent clotting in the venous system is with heparin. And when you have arterial clotting, aspirin works better. So, it makes sense that both would work better than either one alone," says Lockwood, whose own research was cited in the study.

Past research had revealed that up to 7 percent of women who suffer chronic pregnancy loss might be affected by antiphospholipid antibodies. For those at low risk for miscarriage -- women who have the antibodies but have had less than three miscarriages -- having the syndrome can increase the chance of pregnancy loss up to nine times more than normal. For those at high risk for miscarriage -- if three or more pregnancies have already been lost -- the rate of future losses can soar as high as 90 percent.

Unfortunately, says Lockwood, the initial diagnosis of the condition is often wrong, and that's part of the reason why other therapies may have been considered in the past.

"The diagnosis is made far too often on frivolous grounds, and in those settings anything would prove beneficial," says Lockwood, adding this is one reason why treatments that seemed beneficial were later found ineffective.

"The closer you get to the real problem, the more likely it is that the heparin-aspirin combination will work, and we always knew that," says Lockwood.

In a bid to clear up any lingering controversy, the new research relied on a process known as meta-analysis -- a review of qualified data that compares a number of treatments.

"The aim of this systematic review was to explore all potential therapies, highlighting the benefits and risks of the different regimes, and to identify the areas where further research is required," the study authors wrote in the January issue of The Journal of The American College of Obstetrics and Gynecology.

The therapies they examined included aspirin alone, the aspirin-heparin combination, and prednisone (a steroid) with aspirin. Each was, at one time, thought to be the best treatment for the syndrome.

After combing through more than 550 studies, 10 were identified as meeting all the criteria, which included randomized, well-controlled reviews with a large number of participants. A total of 627 women were involved in the 10 trials.

The result: the combination of aspirin and heparin did the best job of preventing pregnancy loss, reducing the rate of miscarriage by some 54 percent -- a success rate far and above the other treatments.

As good as the therapy is, the authors caution that the aspirin-heparin combination has its risks. They include a greater chance for premature birth and fetal growth restriction, and an increased risk of osteoporosis for the mother because of the heparin.

For those facing the highest risk of miscarriage, however, the benefits are "likely to outweigh any risk," the authors say.

Lockwood agrees.

"Among all the treatments we have to reduce the risk of chronic miscarriage related to this disorder, the aspirin-heparin combination does appear to be among the most effective, particularly for women who have experienced multiple losses," he says.

What To Do: To learn more about aspirin-heparin therapy, visit the Genetics and IVF Institute. To understand more about chronic pregnancy loss, and the tests that can reveal the cause, visit the Sher Institute for Reproductive Medicine.

SOURCES: Interviews with Charles Lockwood, M.D., professor and chairman, obstetrics and gynecology, New York University School of Medicine, and director, obstetrics and gynecology, Bellevue Medical Center, New York City; January 2002 Journal of the American College of Obstetrics and Gynecology
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