ALIFE-2: Can anticoagulants prevent miscarriage in women with inherited thrombophilia?

Tommy’s researchers are taking part in a multinational clinical trial to find out whether ‘blood thinning’ treatment helps to prevent miscarriage in women with inherited thrombophilia – a blood clotting disorder – who have had multiple miscarriages.
  • Author's list

    Professor Siobhan Quenby, Professor Arri Coomarasamy, external collaborators

    Start date: 2015
    End date: 2021

Why do we need this research?

Thrombophilia is a condition that increases a person’s chances of having a blood clot. Pregnant women with inherited thrombophilia are thought to be more likely to experience complications during their pregnancy, such as pre-eclampsia, slow growth and recurrent miscarriage

Anticoagulants – or ‘blood-thinning’ medicines – are the main treatment for people with thrombophilia. Many clinicians believe that anticoagulant treatments could improve outcomes for women with inherited thrombophilia who have experienced multiple miscarriages, although the current evidence for their use is inconclusive. More research is needed to show whether this treatment really does help to prevent miscarriage.

What’s happening in this project?

Researchers funded by Tommy’s are taking part in a large, multinational study called ALIFE-2. In this study, women with inherited thrombophilia and a history of at least two previous losses will either be treated with Low Molecular Weight Heparin (LMWH) or receive standard pregnancy monitoring only. LMWH treatment will begin within the first 7 weeks of pregnancy and continue until birth. 

The ALIFE-2 study is being carried out at 40 hospitals in 8 countries around the world. So far, 429 women have agreed to take part, 314 of whom have become pregnant and have been allocated to either treatment with LMWH or standard care. To assess whether treatment with LMWH is beneficial, the researchers want to find out how many women in each group have a live birth. They will check how many women have pregnancy complications such as miscarriage, pre-eclampsia and premature birth, and will also check that there are no safety concerns with LMWH treatment.

What difference will this project make?

This study should finally confirm whether anticoagulant treatment can help to prevent further losses in women with inherited thrombophilia and a history of recurrent miscarriage. If the trial is successful, LMWH could become the standard treatment for these women. However, this study may also show that LMWH treatment does not improve outcomes for these women. If this happens, it would mean that women with inherited thrombophilia and a history of recurrent miscarriage no longer need to receive unnecessary anticoagulant treatment during their pregnancies, and researchers will be able to focus their attention on other promising treatments for these women.