SPIN (Scottish Pregnancy Intervention) study: a multicenter, randomized controlled trial of low-molecular-weight heparin and low-dose aspirin in women with recurrent miscarriage

P Clark, I D Walker, P Langhorne, L Crichton, A Thomson, Michael Greaves, S Whyte, IA Greer

Research output: Contribution to journalArticle

176 Citations (Scopus)

Abstract

To assess whether treatment with enoxaparin and low-dose aspirin, along with intensive pregnancy surveillance, reduces rate of pregnancy loss compared with intensive pregnancy surveillance alone inwomenwith history of 2 or more consecutive previous pregnancy losses, a parallel group, multicenter, randomized controlled trial was performed in the United Kingdom and New
Zealand. Participants (n 294) presenting for initial antenatal care at fewer than
7 weeks’ gestation with history of 2 or more consecutive previous pregnancy losses at 24 or fewer weeks’ gestation and no evidence of anatomic, endocrine, chromosomal, or immunologic abnormality were randomly assigned to receive either enoxaparin 40 mg subcutaneously and 75 mg of aspirin orally once daily along with intense pregnancy surveillance or intense pregnancy surveillance alone from random assignment until 36 weeks’ gestation. The primary outcome measure was pregnancy loss rate. Of the 147 participants receiving pharmacologic intervention, 32 (22%) pregnancy losses occurred, compared with 29 losses (20%) in the 147 subjects receiving intensive surveillance alone, giving an odds ratio of 0.91 (95% confidence interval, 0.52-1.59) of having a successful pregnancy with pharmacologic intervention. Thus, we observed no
reduction in pregnancy loss rate with antithrombotic intervention in pregnant women with 2 or more consecutive previous pregnancy
losses. The trial was registered at http://www.controlled-trials.com as
ISRCTN06774126.
Original languageEnglish
Pages (from-to)4162-4167
Number of pages6
JournalBlood
Volume115
Issue number21
Early online date17 Mar 2010
DOIs
Publication statusPublished - 27 May 2010

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Habitual Abortion
Low Molecular Weight Heparin
Aspirin
Multicenter Studies
Randomized Controlled Trials
Pregnancy
Enoxaparin
Pregnancy Rate
History
Prenatal Care
Pregnant Women
Odds Ratio
Outcome Assessment (Health Care)
Confidence Intervals

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SPIN (Scottish Pregnancy Intervention) study : a multicenter, randomized controlled trial of low-molecular-weight heparin and low-dose aspirin in women with recurrent miscarriage. / Clark, P ; Walker, I D ; Langhorne, P ; Crichton, L ; Thomson, A; Greaves, Michael; Whyte, S; Greer, IA.

In: Blood, Vol. 115, No. 21, 27.05.2010, p. 4162-4167.

Research output: Contribution to journalArticle

Clark, P ; Walker, I D ; Langhorne, P ; Crichton, L ; Thomson, A ; Greaves, Michael ; Whyte, S ; Greer, IA. / SPIN (Scottish Pregnancy Intervention) study : a multicenter, randomized controlled trial of low-molecular-weight heparin and low-dose aspirin in women with recurrent miscarriage. In: Blood. 2010 ; Vol. 115, No. 21. pp. 4162-4167.
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abstract = "To assess whether treatment with enoxaparin and low-dose aspirin, along with intensive pregnancy surveillance, reduces rate of pregnancy loss compared with intensive pregnancy surveillance alone inwomenwith history of 2 or more consecutive previous pregnancy losses, a parallel group, multicenter, randomized controlled trial was performed in the United Kingdom and NewZealand. Participants (n 294) presenting for initial antenatal care at fewer than7 weeks’ gestation with history of 2 or more consecutive previous pregnancy losses at 24 or fewer weeks’ gestation and no evidence of anatomic, endocrine, chromosomal, or immunologic abnormality were randomly assigned to receive either enoxaparin 40 mg subcutaneously and 75 mg of aspirin orally once daily along with intense pregnancy surveillance or intense pregnancy surveillance alone from random assignment until 36 weeks’ gestation. The primary outcome measure was pregnancy loss rate. Of the 147 participants receiving pharmacologic intervention, 32 (22{\%}) pregnancy losses occurred, compared with 29 losses (20{\%}) in the 147 subjects receiving intensive surveillance alone, giving an odds ratio of 0.91 (95{\%} confidence interval, 0.52-1.59) of having a successful pregnancy with pharmacologic intervention. Thus, we observed noreduction in pregnancy loss rate with antithrombotic intervention in pregnant women with 2 or more consecutive previous pregnancylosses. The trial was registered at http://www.controlled-trials.com asISRCTN06774126.",
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