Thread by @DrTiffanyL

@MiddeldorpS starting with a big thank you :) Great job starting off with these #ASH22 difficulties. 1/n

@MiddeldorpS #ALIFE2 study of low molecular weight heparin vs standard pregnancy care RCT for recurrent miscarriage (2+) and inherited thrombophilia - 41 centers in 5 countries! #ASH22 2/n

@MiddeldorpS Intervention was once daily LMWH until delivery. Intent to treat analysis so required 324 randomized evaluable women. They screened more than 10k women for inherited thrombophilia to get these 326 women! Amazing amount of work. #ASH22 3/n

@MiddeldorpS Here were the characteristics of these pregnancy-carrying people - with no difference in primary outcome of live birth numbers. #ash22 4/n

@MiddeldorpS Adverse effects slightly higher in LMWH (injection site reactions mostly, no major bleeding concerns). No difference in study arms for preeclampsia and SGA per @MiddeldorpS #ASH22 5/n

@MiddeldorpS It took 10 years to recruit into this study but we all applaud @MiddeldorpS for doing this study and proving that this can be done. But HUGE conclusions - live birth can happen with standard pregnancy care. Do NOT give to LMWH prevent and, also don't need to test! #ASH22 6/6

@MiddeldorpS Q: what about therapeutic low molecular weight vs prophylactic dose? A: She brought up a medium dose study that also did not who a difference in those arms. #ASH22

@MiddeldorpS Q: were some women on low dose aspirin? A: not many, but per MD preference (mostly for preeclampsia prevention). #ASH22