Aspirin appears to be as effective asenoxaparin for prevention of recurrentmiscarriage in women who have unexplainedreasons for pregnancy loss. Asmall study of 104 women with a historyof at least 3 consecutive miscarriagesshowed equal efficacy with 100 mgdaily of aspirin or 40mg of enoxaparintwice daily. Womenwho had knownpossible causes ofmiscarriage such ashereditary clottingdisorders, cardiovasculardisease,thromboembolism,and abnormal thyroidfunction were excluded from thestudy. Live births occurred in 84% ofwomen on aspirin and 82% of womenon enoxaparin. The study was too smallto detect a statistical difference. Noplacebo arm was included in the study.The authors defended this design bystating that women would not want toenroll in a study such as this knowingthey might be randomized to placebo.A review of historical control patientsshowed a 60% live birth rate after 3 miscarriagesand a 40% live birth rate after4 miscarriages, indicating a possiblebenefit from the use of these medicationsto prevent pregnancy loss. Furtherstudy will be required to fully define therole of these medications.
Dr. Garrett is a clinical pharmacistpractitioner at Cornerstone Health Carein High Point, NC.