Aspirin and heparin Flashcards
What was the ALIFE trial
Aspirin plus Heparin or Aspirin alone in woman with recurrent Miscarriage
ALIFE Anticoagulants for living fetuses
Where and when published
March 2010
New England Journal of Medicine
What is the ALIFE study design
what was the intervention
Partially Double blinded - not heparin just aspirin
Multicentre Randomised placebo control trial
Feb 2004 - Jan 2008
Netherlands based 8 hospitals
- 80 mg aspirin and open label subcutaneous adroparin 2850 IU starting as soon as a pregnancy was viable
- 80mg aspirin
- placebo
How many people
364 woman
What was the primary and secondary outcome
Live birth rate
Miscarriage IUD Obstetric complications - PET, HELLP, SGA< abruption and PTB Maternal and fetal adverse events EBL Neonatal or congential abnormalities
Who were the authors
Kaandorp, Goddijn,
Who was in the study
18- 42 yo
Hx recurrent unexplained miscarriage
Attempting to conceive or less then 6/52 pregnant
Miscarriage : before 20 weeks, not biochemical, +pregnancy test and sx of miscarriage
Recurrent: At least 2 miscarriages
Unexplained: normal karyotype of both partners, absence of uterine disease, absence of antiphospholipid and normal fasting homocysteine
Method
Woman were randomised to one of the three groups
Randomised centrally by a computer system
Aspirin or placebo started at the time of randomisation (may have been pre preg) until 36 weeks, PTB, MC or ectopic
Heparin started once a viable intrauterine pregnancy confirmed and continued until labour
Withdrawn if not pregnant within 2 years / no longer wanted a pregnancy (incuded in ITT)
Standard care with their own team
Recommended folic acid
Platelet counts 12-30 weeks
What was the result
Live birth rate did not differ between the three groups
Aspirin and heparin 54.5%
Aspirin 50.8%
Placebo 57%
Increase tendency to bruise or itch at the injection site with heparin
No difference in secondary outcomes, No adverse maternal events
NO difference for inherited thombophilia - although not powered for this
