It can’t do any harm… the aspirin problem

There is a belief in the Recurrent Miscarriage community (medical practitioners and sufferers) that baby aspirin (75-81mg) can help prevent future miscarriages. The idea is that it thins the blood slightly, meaning that it flows more easily to the uterus, the placenta and the developing baby. This can be effective if the patient has a known blood thickening/clotting issue, for example:

  • the antiphospholipid (aPL) antibody and lupus anticoagulant – this test should be done twice, six weeks apart, when you are not pregnant

Antiphospholipid (aPL) antibodies are known to increase the chance of blood clots. These blood clots can block the blood supply to the foetus, which can cause a miscarriage. (from http://www.nhs.uk/Conditions/Miscarriage/Pages/Diagnosis.aspx)

St Mary’s, London, also perform the TEG test (http://en.wikipedia.org/wiki/Thromboelastography), in which your blood is rushed to be tested straight away, while it’s still fresh to check for clotting disorders. I am due to have this test if and when I am next pregnant. If it is positive, St Mary’s will prescribe 150mg of aspirin.

Many people, health professionals and lay people, advise and would be happy to take baby aspirin ‘just in case’ because it ‘can’t hurt’, and, in the months leading up to MMC3, before and during my pregnancy, I took it daily. I know it thins the blood, because at one stage I was covered in it. But that’s another story. I don’t think it did me any harm (except for maybe enabling me to implant a chromosomally abnormal fertilised egg – I wonder whether it contributed to my uterine lining being ‘less selective’). Baby 3 died of Turner’s Syndrome, and nothing on earth could have prevented that (except, perhaps me being 10 years younger!).

Professors Brosens and Quenby at Coventry do not share the view that aspirin ‘can’t hurt’, in fact they argue that it can be a contributory factor in miscarriage because of the implantation problems it can contribute to. Their article is here: http://www.news-medical.net/news/20130117/Miscarriage-and-molecular-signals-an-interview-with-Prof-Brosens-and-Prof-Quenby.aspx

Whilst it does not directly talk about aspirin here, part of their view is that many women with clotting issues mentioned above had perfectly normal pregnancies, so there must be something else going on. I haven’t seen the data, but that’s what they say. Instead, they recommend heparin injections during pregnancy, which they argue are more beneficial in promoting placenta formation and blood flow. I have been prescribed this for next time, also.

So now I am in the difficult position of having two potentially conflicting action plans from two different top RMC clinics, not to mention the reluctance of my GP to order the heparin injections without first referring me to a haematologist.

Lucky for me, it’s a moot point, for now! But I look forward (!) to arguing for my treatment plan with the top RMC consultants in the country the next time I am pregnant. Because that’s the kind of stress I will need at that point in time.

I’m not a doctor, and I don’t know whether aspirin helps or not. But it is clear that the jury is still out, and more research is needed. It may not prove to be as benign as some people think it is. It certainly does help some women, but my worry is that if that isn’t you, it could just hurt.

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10 thoughts on “It can’t do any harm… the aspirin problem

  1. Thanks for sharing this! I have a lot of the same feelings. And to complicate things, I have a history of stomach ulcers so aspirin is just a really bad idea for me. That said, after talking with our ‘RE, we have decided that I am taking the risk and trying it with our next pregnancy for the first time because no asprin sure hasn’t worked.

  2. Glad you found it of interest. It’s so frustrating, isn’t it, that there isn’t enough research to say exactly whether, how or for whom aspirin helps. I hope it works for you. It’s good to have a plan, though. It does wonders for your sanity! Thank you for reading and commenting.

  3. From my research I understand that the heparin and the aspirin treat slightly different elements of APS. Hence, St Mary’s will prescribe BOTH.
    I really think it is risky to just take it without a diagnosis!

    As someone with APS, the fact some women do OK without it means little to me in terms of writing it off. Because many women with APS don’t have the crippling joint pain, skin rashes and brain fogs I have when not pregnant: symptoms aspirin helps with. Thus, as my losses were related to my APS, it is clear aspirin is doing something for that.
    My heparin injections, as I understand it, help the placenta.
    So what is interesting is that although gut reaction would be the aspirin is the ‘mild’ drug to help the pregnancy and the injected heparin the ‘hard hitter’ for my thrombosis risk, it’s actually the other way round in many cases: the heparin protects the placenta and the aspirin is the pregant-or-not anti coagulant mainstay.

  4. Thanks for your comments, Perdita. I’m glad that you are on a treatment plan that works for you.
    I share your worries that people take it ‘just in case’ because ‘it can’t hurt’, but it’s actually quite a powerful drug. I’ve heard of consultants prescribing it with no medical reason (this did happen to me, and I did take it), and of women hearing that it ‘might help and can’t hurt’ self prescribing it. I know people can be tempted to take all kinds of ‘snake oil’ when nothing else seems to be working, but aspirin does have a known effect. It’s a worry, and I think that without further definitive research, the situation will just continue.
    I hope that things are still going well for you?
    Thanks again for reading and leaving a comment :)

  5. My RE just put me on baby aspirin and progesterone after my two miscarriages…her reasoning is, it can’t hurt! I’m following her advice because I’m desperate, but I don’t think it’s addressing any issues I actually have. It’s so frustrating the lack of research and all the conflicting research we have to contend with. Thank you for this great post!

  6. Alexis, thank you for reading and commenting. I had exactly the same treatment plan after my second miscarriage, and I think that the progesterone did help. It’s very difficult to say whether aspirin did anything either way due to the Turner’s diagnosis on MC3. I wish you all the luck with your next pregnancy; I’m not a doctor and you have to go on the advice that you trust. Maybe discuss it with her is you are concerned? Best wishes.

  7. Wanted to say hello Just. Not sure if you remember but I used to post on the Mumsnet RM thread – must go back and say hello. And found your blog when it was featured by MN.
    Hope you are doing ok – you write really beautifully about things which are so difficult – have shed a year reading, and cracked a smile as sometimes I could be reading about myself! I think we’ve both clocked up a crazy number of operations (I also MMC). Recently had a hysteroscopy at St Mary’s and was v grateful for your tip about no husbands allowed on the ward – was nice to be prepared!
    Anyway sending you hugs and trying to work out how I ‘follow’ you – being thick!

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