New Standard to Prevent Fetal Loss From Antiphospholipid Antibody Syndrome

Laurie Barclay, MD

March 13, 2003

March 13, 2003 — The new standard of care for preventing recurrent fetal loss due to antiphospholipid antibody syndrome (aPL) should be low-molecular-weight heparin (LMWH) plus low-dose aspirin, according to a report in the March issue of Arthritis & Rheumatism. Although intravenous immunoglobulin (IVIG) is seemingly effective, investigators found that LMWH plus low-dose aspirin was substantially more effective than IVIG and recommended that it should be considered as standard therapy.

"Women with aPL have a high frequency of pregnancy loss," write Giovanni Triolo, MD, and colleagues from the University of Palermo in Italy. "Pregnancies can also be complicated by premature delivery and uteroplacental insufficiency. Adverse pregnancy outcomes in these conditions may reflect poor placental perfusion caused by local thrombosis."

After pregnancy was documented with a positive urine test, 40 women, each with at least three spontaneous abortions and repeatedly positive tests for anticardiolipin or lupus anticoagulant, were randomized to treatment with IVIG or LMWH plus low-dose aspirin. IVIG treatment was stopped at the 31st week of pregnancy, aspirin at the 34th week, and LMWH at the 37th week.

Live birth rate was 84% in the LMWH plus aspirin group, and 57% in the IVIG group (odds ratio, 0.25; 95% confidence interval, 0.05 - 1.13). Most miscarriages occurred in the first trimester.

"Treatment with LMWH plus low-dose aspirin should be considered as the standard therapy for recurrent pregnancy loss due to aPL," the authors write. "Long-term use of LMWH was also associated with few complications and may require less frequent laboratory follow-up."

Arthritis Rheum. 2003;48:728-731

Reviewed by Gary D. Vogin, MD

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