ALIFE study Anticoagulatns for Living Fetuses

Question 1

Aspirin + heparin or Aspirin alone in women with recurrent miscarriage (ALIFE Study)
- design, N

Answer 1

Kaandorp et al
NEJM 201
N = 364
8 centres, Multicentre RCT

Incl criteria
18-42yo with Hx of >2 unexplained losses < 20/40, attempting to conceive or < 6/40 preg
randomised to (to take until 36/40):
- Aspirin 80mg + Nadroparin 2850IU heparin
- Aspirin 80mg alone
- Placebo

Exclusion: - PHx of venous or arterial thrombo-embolism, APLS, karyotype, pelvic structural abnormality

Question 2

Outcomes: Aspirin + heparin or Aspirin alone in women with recurrent miscarriage (ALIFE Study)

Answer 2

Primary: Live birth rate [no diff – 54.5% combo vs 50.8% aspirin vs 57% placebo]

Secondary:

• Miscarriage/IUFD
• Obstetric complications (inc PET/HELLP, SGA, PTB, abruption)
• Maternal/fetal adverse events
• Maternal SEs (bruising, itch, swelling) – 50% in combo group

 Overall no diff

Question 3

Conclusion: Aspirin + heparin or Aspirin alone in women with recurrent miscarriage (ALIFE Study)

Answer 3

No diff in LBR in unexplained recurrent miscarriages (though ACOG guidelines - 2).

Thus do NOT support combo or aspirin to improve chances of live birth in this group.