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The effect of low-molecular-weight heparin on live birth rate of patients with unexplained early recurrent pregnancy loss: A two-arm randomized clinical trial
Azam Mohammad-Akbari1, Arash Mohazzab2, Maryam Tavakoli3, Atousa Karimi1, Simin Zafardoust1, Zhaleh Zolghadri1, Shadab Shahali4, Reyhane Tokhmechi5, Soheila Ansaripour1
1 Reproductive Biotechnology Research Center, ACECR, Avicenna Research Institute; Avicenna Fertility Center, Tehran, Iran
2 Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
3 Reproductive Biotechnology Research Center, ACECR, Avicenna Research Institute, Tehran, Iran
4 Department of Reproductive Health and Midwifery, Tarbiat Modares University, Tehran, Iran
5 Avicenna Fertility Center, Tehran, Iran
Correspondence Address:
Prof. Soheila Ansaripour
Avicenna Research Institute, Evin, Daneshjoo Blvd, Chamran Exp.Way, Tehran 1936773493
Iran
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jrms.jrms_81_21
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Background: The effect of anticoagulant medication in unexplained early recurrent pregnancy loss (RPL) patients is controversial. This clinical trial evaluated the effect of low-molecular-weight heparin (LMWH) on pregnancy outcomes in these patients. Materials and Methods: The study was performed as a single-blind randomized clinical trial between 2016 and 2018. Samples were selected from patients who were referred to Avicenna RPL clinic with a history of at least two previously happened early unexplained miscarriages. The eligibility was defined strictly to select unexplained RPL patients homogenously. One hundred and seventy-three patients who got pregnant recently were allocated randomly into two groups LMWH plus low-dose aspirin treatment (Group A = 85) and low-dose aspirin treatment only (Group B = 88)) and were followed up till their pregnancy termination (delivery/abortion). A per-protocol analysis was carried out and all statistical tests were two-sided with a P < 0.05 significance level. Results: The live birth rates (LBRs) in Groups A and B were 78% and 77.1%, respectively, which did not show any statistically significant difference between the two groups, neither in rates nor in time of abortion. In subgroup analysis for polycystic ovary syndrome (PCOS) patients, the odds ratio for study outcome (intervention/control) was 2.25 (95% confidence interval: 0.65–7.73). There was no major adverse event whereas minor bleeding was observed in 18% of patients in Group A. Conclusion: LMWH does not improve the LBR in unexplained RPL patients, however, it is recommended to evaluate its effect separately in PCOS patients.
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