Randomized study of subcutaneous low molecular weight heparin plus aspirin versus intravenous immunoglobulin in the treatment of recurrent fetal loss associated with antiphospholipid antibodies

Arthritis Rheum. 2003 Mar;48(3):728-31. doi: 10.1002/art.10957.


Objective: To compare the 2 most efficacious therapeutic regimens, intravenous immunoglobulin (IVIG) and anticoagulation with low molecular weight (LMW) heparin plus low-dose aspirin, in women with recurrent pregnancy loss associated with antiphospholipid antibodies (aPL).

Methods: We examined 40 women with recurrent abortion (at least 3 occurrences) and repeatedly positive test results for anticardiolipin or lupus anticoagulant. The subjects were randomly assigned to treatment with IVIG or LMW heparin plus low-dose aspirin. Both therapies were started when the women were pregnant as documented by a positive urine test. IVIG was stopped at the thirty-first week of gestation, aspirin at the thirty-fourth week, and heparin at the thirty-seventh week. The primary outcome of interest was the rate of live births with the 2 treatments.

Results: The characteristics of the 2 groups were similar at the time of randomization. The women treated with LMW heparin plus low-dose aspirin had a higher rate of live births (84%) than those treated with IVIG (57%).

Conclusion: Treatment with LMW heparin plus low-dose aspirin should be considered as the standard therapy for recurrent pregnancy loss due to aPL.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abortion, Habitual / etiology
  • Abortion, Habitual / prevention & control*
  • Adolescent
  • Adult
  • Anticoagulants / administration & dosage
  • Anticoagulants / therapeutic use*
  • Antiphospholipid Syndrome / complications
  • Antiphospholipid Syndrome / drug therapy*
  • Aspirin / therapeutic use*
  • Drug Therapy, Combination
  • Female
  • Heparin, Low-Molecular-Weight / therapeutic use*
  • Humans
  • Immunoglobulins, Intravenous / therapeutic use*
  • Pregnancy
  • Pregnancy Complications*
  • Pregnancy Outcome
  • Random Allocation
  • Treatment Outcome


  • Anticoagulants
  • Heparin, Low-Molecular-Weight
  • Immunoglobulins, Intravenous
  • Aspirin