WOMENS-HEALTH Messages for August, 1997: Re: baby aspirin to prevent miscarriage

Re: baby aspirin to prevent miscarriage

From: Kelly (anonymous@obgyn.net)
Thu, 28 Aug 1997 19:22:43 -0500 (CDT)

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In reply to: Mary: "baby aspirin to prevent miscarriage"

>After a miscarriage, a year of trying to get pregnant with no success,
>and then another heartbreaking miscarriage, my reproductive
>endocrinologist ordered a bunch of blood tests to see why I am
>miscarrying. They're all back (except the karyotypes) and the only one
>that came back abnormal was some kind of clotting test. (I know the
>proper names, I just don't know which test it was.) So he has prescribed
>one baby aspirin every day. Nothing else.
>
>This makes me VERY nervous. How can such a little pill make any
>difference? I would think that I would need Heparin or something too.
>
>Luckily, we are not able to start trying to get pregnant again because I
>have to have a laparoscopy/hysteroscopy.
>
>I've heard of this baby aspirin therapy before, but it is just hard to
>believe it would help much.
>Any input is very welcome!

Mary Ellen

I'm sorry for your losses -- I've been there twice, too, and am currently summoning up the courage to try again.

It sounds as if you had a mildly abnormal anticardiolipin antibody or lupus anticoagulant; both of these are part of the "antiphospholipid antibody" family. The presence of these antiphospholipids is thought to possibly interfere with the ability of the placenta to function properly. One way of looking at is that the antiphospholipids cause little tiny clots in the blood vessels of the uterine wall and placenta.

Aspirin makes platelets less sticky -- that's why aspirin is a "blood thinner". It is used to prevent these little placental blood clots.

Some REs use aspirin alone if the tests are borderline. Others believe the combination of aspirin and heparin, another blood thinner, is more effective. Heparin is given by injection twice a day, is more expensive and has more risks than aspirin alone. Risks of heparin include infection at the site of injection, bleeding and bruising, and thinning of bones.

You should sit down with your doctor and ask why she/he has recommended aspirin alone versus aspirin + heparin. It may be that based on your particular test results, she/he feels aspirin alone is enough and the addition of heparin is not worth the additional risks. Together, you can decide which regimen is best for you -- your comfort level, in my opinion, should be a factor in that decision. (when I went to my RE with a borderline test result, I begged him to tell me what to do -- I was sick of treating myself and making decisions. He, quite wisely, reviewed everything with me and then asked "how will you feel if you do not do the therapy and you miscarry again and how will you feel if you do use it, but you miscarry any way?" That's what I mean by comfort level)

Best of luck to you,

-- Kelly Shanahan, MD, FACOG S. Lake Tahoe, CA

note: Opinions here are for educational purposes only. This information is not intended to supplant the need for you to consult with your own physician. It cannot take the place of a face to face consultation and examination.

Next message: Kelly: "Re: aspirin to prevent some late losses?"
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In reply to: Mary: "baby aspirin to prevent miscarriage"

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