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Preeclampsia SeverePhase 4preGONCT07361679

LDA and LMWH vs LDA Alone in High-risk Patients for Preeclampsia Prevention

A Phase 4 study testing Aspirin and Tinzaparin in people with Preeclampsia Severe and Toxemia Of Pregnancy, run by Alexandra Hospital, Athens, Greece at 1 site in Greece.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

Preeclampsia is a major cause of maternal and perinatal morbidity and mortality worldwide. Low-dose aspirin started in the first trimester reduces the risk of preeclampsia in high-risk women. Read more about this study

Who is it for?
Ages 18 years and older, women only
What is being tested?
Aspirin and Tinzaparin
Could I receive a placebo?
No, everyone receives an active treatment
How many people
100 participants
Where
1 siteGreece
Study dates
18 Jan 2023to 1 Jul 2027
Phase
Phase 4
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • Women only
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Singleton pregnancy
  • High risk for preeclampsia (risk >1:150) based on FMF screening algorithm combining first-trimester ultrasound, biochemical markers, and medical history
  • Gestational age <16 weeks at enrollment
  • Maternal age ≥18 years
  • Willing and able to provide written informed consent
  • Adequate ability for follow-up (direct telephone communication, accessible residence)

Who cannot join

  • Multiple pregnancy
  • Current permanent aspirin use for other medical indications
  • Serious congenital fetal abnormality detected on ultrasound
  • Contraindication to aspirin or low molecular weight heparin including: known hypersensitivity, active peptic ulcer disease, bleeding disorders or coagulopathy, severe thrombocytopenia (platelet count <100,000/μL), active or recent significant bleeding, history of heparin-induced thrombocytopenia
  • Pre-existing severe renal failure (creatinine clearance <30 mL/min)
  • Unable to provide informed consent
  • Low probability of adequate follow-up (residence in remote areas without telephone access, accommodation in temporary structures)

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Dimitrios Baroutis, MD, MSc, PhD(c) contact

+306978275745

dbaroutis@gmail.com

Greece1 site, 1 recruiting
  • First Department of Obstetrics and Gynecology, Alexandra Hospital

    Athens, Attica, 11528

    Dimitrios Baroutis, MD, MSc, PhD(c), +30 6978275745, dbaroutis@gmail.com

    Georgios Daskalakis, MD, PhD, +30 6945235757, gdaskalakis@yahoo.com

    Recruiting

Other trials in Greece

About this study

Official title: Combined Administration of Low Molecular Weight Heparin and Aspirin Versus Aspirin Alone in Gravidas at High Risk for Preeclampsia: A Randomized Controlled Trial

Preeclampsia is a major cause of maternal and perinatal morbidity and mortality worldwide. Low-dose aspirin started in the first trimester reduces the risk of preeclampsia in high-risk women. Low molecular weight heparin (LMWH) has shown potential benefits in addition to aspirin for preventing preeclampsia through its anticoagulant, anti-inflammatory, and endothelial protective effects. However, current evidence is limited and conflicting regarding the added value of LMWH to aspirin. This randomized controlled trial aims to evaluate the efficacy of combined aspirin and LMWH, compared to aspirin alone, for reducing the incidence of preeclampsia in high-risk gravidas.

Read the detailed description

This is a prospective, randomized, single-center, open-label trial conducted at the First Obstetrics and Gynecology Clinic of Alexandra Hospital, Athens, Greece. One hundred pregnant women at high risk of preeclampsia (risk >1:150) will be randomly allocated 1:1 to receive either 160mg aspirin daily (n=50) or 160mg aspirin plus weight-adjusted therapeutic doses of LMWH (tinzaparin 4,500-8,000 IU daily based on weight) (n=50) initiated before 16 weeks gestation until 36 weeks.

Risk assessment will be performed using the internationally recognized FMF (Fetal Medicine Foundation) model, combining first trimester ultrasound examination, biochemical markers, and individual medical history.

The primary outcome is the incidence of preeclampsia. Secondary outcomes include development of early preeclampsia (<34 weeks), gestational hypertension, HELLP syndrome, spontaneous preterm labor, intrauterine growth restriction, placental abruption, and various neonatal outcomes.

Blood samples will be collected at 20-24, 32-34, and 36 weeks to measure biomarkers including PlGF, sFlt-1, E-Selectin, IL-1β, IL-6, IL-10, TNF-α, sFlt-1/PlGF ratio, and systemic immune-inflammation index (SII). Regular telephone follow-up will be conducted to monitor adherence and adverse events.

Being tested
Aspirin, Tinzaparin
Keywords
preeclampsia, gestational hypertension, toxemia, Preeclampsia prevention, Low molecular weight heparin, tinzaparin, High-risk pregnancy, LMWH, Maternal-fetal medicine
Medical subject headings
Pre-Eclampsia, Pregnancy Complications, Hypertension, Pregnancy-Induced, Toxemia

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • AspirinDrug

    Also called ASA, Low-dose aspirin, Acetylsalicylic acid

    Aspirin 160 mg orally once daily before bedtime. Duration: From enrollment (<16 weeks gestation) until 36 weeks gestation.

  • TinzaparinDrug

    Also called Low molecular weight heparin, Innohep, LMWH

    Weight-adjusted tinzaparin administered subcutaneously once daily in the morning: 4,500 Anti-Xa IU/day for weight ≤60 kg, 6,000 Anti-Xa IU/day for weight 60-90 kg, and 8,000 Anti-Xa IU/day for weight >90 kg. Duration: From enrollment (<16 weeks gestation) until 36 weeks gestation.

Study groups in NCT07361679
Study groupRoleWhat they receive
Aspirin AloneActive comparatorParticipants receive aspirin 160 mg orally once daily before bedtime from enrollment (<16 weeks gestation) until 36 weeks gestation.
Receives: Drug: Aspirin
Aspirin plus LMWHExperimentalParticipants receive aspirin 160 mg orally once daily before bedtime PLUS weight-adjusted tinzaparin subcutaneously once daily in the morning (4,500 Anti-Xa IU for weight ≤60 kg, 6,000 Anti-Xa IU for weight 60-90 kg, 8,000 Anti-Xa IU for weight >90 kg) from enrollment (<16 weeks gestation) until 36 weeks gestation.
Receives: Drug: Aspirin; Drug: Tinzaparin

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Incidence of Preeclampsia

    Preeclampsia defined as gestational hypertension (BP ≥140/90 mmHg on at least two measurements ≥4 hours apart) after 20 weeks' gestation accompanied by one or more of: (1) Proteinuria (≥30 mg/mmol protein:creatinine ratio, ≥8 mg/mmol albumin:creatinine ratio, ≥0.3 g/24h, or ≥2+ dipstick); (2) Maternal end-organ dysfunction including neurological complications (severe headaches, visual scotomata, eclampsia, stroke, clonus), pulmonary oedema, haematological complications (platelet count <150,000/μL, disseminated intravascular coagulation, haemolysis), acute kidney injury (creatinine ≥90 μmol/L or 1 mg/dL), or liver involvement (elevated ALT or AST >40 IU/L); or (3) Uteroplacental dysfunction (fetal growth restriction, abnormal umbilical artery Doppler waveform analysis, placental abruption, angiogenic imbalance, or intrauterine fetal death), per ISSHP 2021 classification.

    Measured: From enrollment until delivery (up to 40 weeks gestation)

Secondary outcomes (14)
  1. Systemic Immune-Inflammation Index (SII)

    Systemic immune-inflammation index calculated as SII = P × N/L, where P, N, and L are the peripheral blood platelet count, neutrophil count, and lymphocyte count respectively (cells per liter)

    Measured: At 20-24 weeks, 32-34 weeks, and 36 weeks gestation

  2. Incidence of Preterm Preeclampsia

    Development of preeclampsia before 37 weeks gestation

    Measured: From enrollment until 37 weeks gestation

  3. Prevalence of placental histopathological lesions

    Histopathological examination of placental tissue including assessment of maternal vascular malperfusion, fetal vascular malperfusion, villous lesions, inflammatory lesions, and other pathological findings according to standardized criteria

    Measured: At delivery

  4. Soluble fms-like Tyrosine Kinase-1 (sFlt-1) Levels

    Serum levels of soluble fms-like tyrosine kinase-1 (sFlt-1) measured by immunoassay

    Measured: At 20-24 weeks, 32-34 weeks, and 36 weeks gestation

  5. Placental Growth Factor (PlGF) Levels

    Serum levels of placental growth factor (PlGF) measured by immunoassay

    Measured: At 20-24 weeks, 32-34 weeks, and 36 weeks gestation

  6. sFlt-1/PlGF Ratio

    Ratio of soluble fms-like tyrosine kinase-1 to placental growth factor (sFlt-1/PlGF ratio) measured by immunoassay

    Measured: At 20-24 weeks, 32-34 weeks, and 36 weeks gestation

  7. Interleukin-6 (IL-6) Levels

    Serum levels of interleukin-6 (IL-6) measured by immunoassay

    Measured: At 20-24 weeks, 32-34 weeks, and 36 weeks gestation

  8. Incidence of Early-Onset Preeclampsia

    Development of preeclampsia before 34 weeks gestation (early-onset preeclampsia)

    Measured: From enrollment until 34 weeks gestation

  9. Incidence of Gestational Hypertension

    New-onset hypertension (blood pressure ≥140/90 mmHg on two occasions at least 4 hours apart) after 20 weeks gestation without proteinuria or evidence of end-organ dysfunction

    Measured: From 20 weeks gestation until delivery (up to 40 weeks)

  10. Rate of Spontaneous Preterm Birth

    Spontaneous preterm labor resulting in delivery before 34 weeks gestation and before 37 weeks gestation

    Measured: From enrollment until delivery, assessed up to 40 weeks gestation

  11. Incidence of Small for Gestational Age

    Birth weight below the 3rd, 5th, and 10th percentile for gestational age based on standardized fetal growth charts (small for gestational age)

    Measured: At delivery

  12. Perinatal Death

    Miscarriage, intrauterine fetal death, or neonatal death within 28 days after birth attributed to preeclampsia or fetal growth restriction

    Measured: From enrollment until 28 days after delivery

  13. Neonatal Complications and Therapy

    Composite of neonatal adverse outcomes including sepsis, intraventricular hemorrhage grade III-IV, necrotizing enterocolitis, respiratory distress syndrome (RDS), need for surfactant therapy, mechanical ventilation, blood transfusion, and admission to neonatal intensive care unit (NICU) with duration of stay

    Measured: From delivery until hospital discharge (up to 3 months)

  14. Placental Abruption

    Premature separation of the placenta from the uterine wall before delivery

    Measured: From enrollment until delivery (up to 40 weeks gestation)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted23 Jan 2026
  2. Study start18 Jan 2023
  3. Primary completion1 Aug 2026 (estimated)
  4. Study completion1 Jul 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Model description
Two parallel groups: Arm 1 receives aspirin alone, Arm 2 receives aspirin plus weight-adjusted LMWH
Masking
None (open label)
Enrolment
100 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07361679
Sponsor's protocol ID
724/23-11-2022
Acronym
preGO
Status last verified
Jan 2026
First submitted
21 Dec 2025
Last updated
23 Jan 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided: The decision on individual participant data sharing will be made in accordance with institutional policies and ethical requirements. The data sharing plan will be finalized prior to study completion and publication of results.

Publications

  • McLaughlin K, Baczyk D, Potts A, Hladunewich M, Parker JD, Kingdom JC. Low Molecular Weight Heparin Improves Endothelial Function in Pregnant Women at High Risk of Preeclampsia. Hypertension. 2017 Jan;69(1):180-188. doi: 10.1161/HYPERTENSIONAHA.116.08298. Epub 2016 Nov 13.

    PubMed 27840330
  • Cruz-Lemini M, Vazquez JC, Ullmo J, Llurba E. Low-molecular-weight heparin for prevention of preeclampsia and other placenta-mediated complications: a systematic review and meta-analysis. Am J Obstet Gynecol. 2022 Feb;226(2S):S1126-S1144.e17. doi: 10.1016/j.ajog.2020.11.006. Epub 2021 Apr 20.

    PubMed 34301348
  • Wright D, Wright A, Nicolaides KH. The competing risk approach for prediction of preeclampsia. Am J Obstet Gynecol. 2020 Jul;223(1):12-23.e7. doi: 10.1016/j.ajog.2019.11.1247. Epub 2019 Nov 13.

    PubMed 31733203
  • Magee LA, Brown MA, Hall DR, Gupte S, Hennessy A, Karumanchi SA, Kenny LC, McCarthy F, Myers J, Poon LC, Rana S, Saito S, Staff AC, Tsigas E, von Dadelszen P. The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens. 2022 Mar;27:148-169. doi: 10.1016/j.preghy.2021.09.008. Epub 2021 Oct 9.

    PubMed 35066406
  • Rolnik DL, Wright D, Poon LC, O'Gorman N, Syngelaki A, de Paco Matallana C, Akolekar R, Cicero S, Janga D, Singh M, Molina FS, Persico N, Jani JC, Plasencia W, Papaioannou G, Tenenbaum-Gavish K, Meiri H, Gizurarson S, Maclagan K, Nicolaides KH. Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia. N Engl J Med. 2017 Aug 17;377(7):613-622. doi: 10.1056/NEJMoa1704559. Epub 2017 Jun 28.

    PubMed 28657417
  • Magee LA, Nicolaides KH, von Dadelszen P. Preeclampsia. N Engl J Med. 2022 May 12;386(19):1817-1832. doi: 10.1056/NEJMra2109523. No abstract available.

    PubMed 35544388

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Aspirin and Tinzaparin in people with Preeclampsia Severe and Toxemia Of Pregnancy, run by Alexandra Hospital, Athens, Greece at 1 site in Greece.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 23 Jan 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Greece. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Dimitrios Baroutis, MD, MSc, PhD(c) (+306978275745, dbaroutis@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Incidence of Preeclampsia (time frame: From enrollment until delivery (up to 40 weeks gestation)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07361679, which also lists 6 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 23 Jan 2026.

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