SPIN

Question 1

SPIN

What is the name of the trial

Answer 1

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

Question 2

SPIN
Authors
Where was it published

Answer 2

Clark, walker, Langhorne et al

Blood 2010

Question 3

SPIN

Where when

Answer 3

NZ and UK 2004 - 2008 
Multicentre RCT (not blind)

Question 4

SPIN

Outcomes

Answer 4

Loss of the index pregnancy

Secondary - complications of tx

Question 5

SPIN

Method

Answer 5

294 randomized (147 each arm) to anticoagulation or monitoring
Randomisation by telephone - randomized envelopes
Both groups 2 weekly USS until 12 weeks then monthly until 28 weeks
FBC in treatment arm 7 days 28/40 36/40
Both groups had thrombophilia testing at booking at at 12 weeks

Question 6

SPIN

intervention

Answer 6

75 mg aspirin and 40 mg LMWH and close monitoring vs close monitoring

Question 7

SPIN population

Inclusion and exclusions

Answer 7

Most recent consecutive 2 pregnancies were lost <24 weeks Presentation for AN care <7 weeks with positive pregnancy test

Exclusions
Previous investigations that had determined that the fetal loss was due to another cause
anatomic, chromosomal, endocrine, immunologic cause
Previous VTE
Known APS or thrombophilia or new Dx APS
Condition that needed Tx Anaemia requiring transfusion Platelets <150
Abnormal TFTs

Question 8

SPIN

hypothesis

Answer 8

To assess if aspirin and LMWH + intensive pregnancy surveillance vs intensive surveillance alone reduces rate of pregnancy loss

Question 9

SPIN Results

Answer 9

22% pregnancy loss in intervention group vs 20% in control group - no statistical significance
Therefore no benefit in giving aspirin and clexane for recurrent pregnancy loss
no complications of tx

Question 10

SPIN strengths and weaknesses

Answer 10

Not able to do subgroup analysis
Not blinded
50% had 2 or more losses - ? if it would help 3 or more losses
Strength RCT Adequately powered

Question 11

SPIN Discussion

Answer 11

Study may not be applicable to those with >/=3 recurrent pregnancy losses. Outcomes seem the same in treatment and control groups in this subgroup analysis however
Overall successful pregnancy rates of 79.2% the same as reported 80%
Further studies on the use of LMWH and aspirin at the time of implantation for those with recurrent pregnancy loss and inherited thrombophilia