Time to stop routine prescription of low-molecular-weight heparin to women with recurrent pregnancy loss and inherited thrombophilia

There has been a knowledge gap concerning the effect of anticoagulant treatment for recurrent pregnancy loss in women with hereditary thrombophilia. In the updated guideline from the European Society of Human Reproduction and Embryology on recurrent pregnancy loss from 2022, 1 ESHRE Recurrent Pregnancy Loss Guideline Development GroupRecurrent pregnancy loss: guideline of European Society of Human Reproduction and Embryology. https://www.eshre.eu/Guidelines-and-Legal/Guidelines/Recurrent-pregnancy-lossDate: Feb 1, 2023 Date accessed: June 20, 2023 Google Scholar there is a conditional recommendation not to use low-molecular-weight heparin (LMWH), based on low certainty of evidence. This called for another trial, particularly as LMWH was still being prescribed by many clinicians. In The Lancet, Siobhan Quenby and colleagues presented the results of the ALIFE2 trial, an international collaborative effort to fill that knowledge gap. 2 Quenby S Booth K Hiller L et al. Heparin for women with recurrent miscarriage and inherited thrombophilia (ALIFE2): an international open-label, randomised controlled trial. Lancet. 2023; (published online May 31.)https://doi.org/10.1016/S0140-6736(23)00693-1 Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar Recruitment of 326 women took 8·5 years to complete, a long time for a randomised controlled trial to run, and the investigators are to be commended for their persistence. Heparin for women with recurrent miscarriage and inherited thrombophilia (ALIFE2): an international open-label, randomised controlled trialLMWH did not result in higher livebirth rates in women who had two or more pregnancy losses and confirmed inherited thrombophilia. We do not advise use of LMWH in women with recurrent pregnancy loss and inherited thrombophilia, and we advise against screening for inherited thrombophilia in women with recurrent pregnancy loss. Full-Text PDF