SPIN study RCT LMWH and low-dose aspirin recurrent miscarriage

Question 1

SPIN study Scottish Pregnancy Intervention Study: RCT LMWH and low-dose aspirin recurrent miscarriage

Answer 1

Clark et al
Blood 2010
Multicentre RCT

N = 294

Women with > 2 consecutive preg losses <24/40, <7/40 at entry,
randomised to:
- Clexane 40mg SC + Aspirin 75mg PO (until 36/40)
- Intense surveillance (US q2/52 until 12/40, then q4/52 until 28/40; with CBE 7-10/7 after Rx then at 28 + 36/40

Question 2

Exclusion SPIN study Scottish Pregnancy Intervention Study: RCT LMWH and low-dose aspirin recurrent miscarriage

Answer 2

Exclusion:

• PHx thrombosis
• PHx chromosome, immune, endocrine, anatomical abnormality
• Known APLS
• Known thrombophilia

Question 3

Outcomes: SPIN study Scottish Pregnancy Intervention Study: RCT LMWH and low-dose aspirin recurrent miscarriage

Answer 3

Primary - Pregnancy loss rate [22% vs 20%; RR 0.91 – no diff]

CONCLUSION:
No inc preg loss rate with anti-thrombotic Rx if no Dx of APLS – thus do NOT support its use

Though longer trials needed.

NB: inc women with only > 2 losses – NOT definition of recurrent miscarriage in Aust