title: Randomized controlled study of pre-conception thromboprophylaxis among patients with recurrent spontaneous abortion related to antiphospholipid syndrome.
abstract: OBJECTIVE
  To investigate the effects of pre-conception thromboprophylaxis among patients with recurrent spontaneous abortion and antiphospholipid syndrome.
  
  
  METHODS
  A randomized placebo-controlled trial enrolled patients with a history of recurrent spontaneous abortions and antiphospholipid syndrome who attended an Egyptian center between January 2011 and June 2013. Using a computer-generated sequence, patients were randomly allocated to receive 41 mg enoxaparin subcutaneously plus 81 mg aspirin daily pre-conception, or to receive placebo pre-conception. All patients received enoxaparin and aspirin following identification of fetal heart pulsation. The primary outcomes were live-birth rate and clinical-pregnancy rate at 0-6 months, and at 6-12 months. Intention-to-treat analyses were performed. Clinicians, investigators, and data analysts were masked to the treatment assignments.
  
  
  RESULTS
  The study enrolled 180 patients(90 in each group). No significant difference was observed between the intervention and control groups in the live-birth rate (67[74%] vs 59[66%]; P=0.25). At 0-6 months, the clinical-pregnancy rate was higher in the intervention group (50[56%]vs 30[33%], P=0.02). No significant difference between the intervention and control groups was observed in the clinical-pregnancy rate at 6-12 months (32[36%] vs 35[39%], P=0.52).
  
  
  CONCLUSIONS
  Among patients with recurrent spontaneous abortion and antiphospholipid syndrome, pre-conception enoxaparin increased the clinical-pregnancy rate at 0-6 months, but did not affect the clinical-pregnancy rate at 6-12 months or the live-birth rate. ClinicalTrials.gov: NCT01661439.
authors.affiliation: Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut University, Assiut, Egypt. Electronic address: prof.alaaismail@gmail.com.
authors.forename: Alaa M
authors.initials: AM
authors.lastname: Ismail
authors.affiliation: Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut University, Assiut, Egypt.
authors.forename: Ali H
authors.initials: AH
authors.lastname: Hamed
authors.affiliation: Division of Surgery and Cancer, Imperial College, London, UK.
authors.forename: Srdjan
authors.initials: S
authors.lastname: Saso
authors.affiliation: Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut University, Assiut, Egypt.
authors.forename: Ahmad M
authors.initials: AM
authors.lastname: Abu-Elhasan
authors.affiliation: Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt.
authors.forename: Mona M
authors.initials: MM
authors.lastname: Abu-Elghar
authors.affiliation: Department of Obstetrics and Gynecology, EL-Minia university, El-Minia, Egypt.
authors.forename: Aymen N
authors.initials: AN
authors.lastname: Abdelmeged
mesh_terms: D000026:Abortion, Habitual / Q000188:drug therapy* / Q000209:etiology; D000328:Adult; D016736:Antiphospholipid Syndrome / Q000150:complications*; D001241:Aspirin / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D004534:Egypt; D017984:Enoxaparin / Q000008:administration & dosage; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D057194:Intention to Treat Analysis; D050498:Live Birth; D016742:Preconception Care / Q000379:methods*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000517:prevention & control*; D018873:Pregnancy Rate
chemical_list: D017984:Enoxaparin; D005343:Fibrinolytic Agents; D001241:Aspirin
keywords: Antiphospholipid syndrome; Pre-conception; Pregnancy; Recurrent spontaneous abortion; Thromboprophylaxis