Heparin plus aspirin confirmed as effective for reducing pregnancy loss in APS

A new meta-analysis has supported the common clinical practice of combining heparin with aspirin to reduce recurrent pregnancy loss in women with antiphospholipid syndrome (APS). Data from 334 patients enrolled in five randomised controlled trials showed that heparin and aspirin, compared to aspirin alone, increased the likelihood of a live birth by 30%. Treating just 5.6 women with the combination would achieve one additional live birth, the study authors estimated. There were no differences between the two treatment groups in pre-eclampsia, preterm labour or birth weight. “Despite more than a decade of research, substantial evidence on treatments to enhance successful pregnancy and live birth in mothers with APS is grossly lacking,” the researchers said. There were few clinical studies of treatment for the condition and they included small numbers of patients, reflecting the general difficulties of conducting trials during pregnancy. Unwillingness to participate and ethical issues, including the use of placebos, made it difficult to design and conduct such studies, the researchers said. Writing in Rheumatology, the authors said the exact mechanism by which heparin improved pregnancy outcomes was not fully understood. Apart from preventing thrombosis and subsequent placental infarcts it was also known to bind to antiphospholipid antibodies, perhaps rendering them inactive, they said. Rheumatology 2010; 49: 281-288....