Treatment with heparin and aspirin has been shown to improve pregnancy outcomes, particularly for women with a history of late fetal loss and those with thrombophilic conditions such as antiphospholipid syndrome (APS).
What Does the Evidence Say?
- Studies demonstrate that the combination of low-dose aspirin and heparin can benefit women with recurrent pregnancy loss (RPL) associated with specific conditions like APS or inherited thrombophilia.
- Heparin’s anti-inflammatory and anticoagulant effects reduce miscarriages by preventing blood clots in placental vessels and modulating immune responses. Aspirin helps by thinning the blood and improving blood flow.
- However, for idiopathic recurrent pregnancy loss (where no cause is identified), evidence suggests that aspirin alone may have similar effectiveness to the combination therapy. A large study showed live birth rates of about 79.8% with aspirin alone and 76.4% with aspirin plus heparin without significant difference in general unexplained cases.
- In contrast, women with recurrent late fetal loss or three or more pregnancy losses, or positive lupus anticoagulant tests, are more likely to benefit from combined therapy.
Summary Table of Findings
| Treatment | Live Birth Rate (%) | Notes |
|---|---|---|
| Aspirin alone | ~79.8 | Easier to administer, oral medication |
| Aspirin + Heparin | ~76.4 – 92.5 | More beneficial for APS and thrombophilic patients |
| No medication | ~60 | Lower success rate |
Conclusion
Heparin combined with aspirin improves outcomes for women with recurrent pregnancy loss due to specific causes like thrombophilia or late fetal loss. However, for unexplained or early losses, aspirin alone may be equally effective and more convenient. The decision to use combination therapy is best personalized based on patient history, underlying conditions, and specialist evaluation.