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Treatment of Patients With Antiphospholipid Antibodies During Pregnancy
- Source :
- American Journal of Reproductive Immunology. 28:216-218
- Publication Year :
- 1992
- Publisher :
- Wiley, 1992.
-
Abstract
- Most authors agree upon the causal association between antiphosholipid antibodies [lupus anticoagulant (LAC) and/or anticardiolipin antibodies] and adverse pregnancy outcome. Placental insufficiency, caused by thrombosis, infarction and maldevelopment, is thought to be the main cause of fetal loss in patients with LAC. Therapy given thus far to prevent fetal loss can be divided into (1) immunosuppression by corticosteroids, azathioprine, or intravenous gamma globulin (IVGG), (2) anti-aggregants to overcome imbalance of thromboxane/prostacycline production in patients with LAC, and (3) anticoagulants to neutralize the possible impairment of clotting inhibitor systems. Different therapeutic success rates have been reported by various authors who used the same combination of therapy. We report the results of different therapy regimens in 154 pregnancies in 31 women with LAC. These patients suffered from SLE with LAC or from APLA syndrome and experienced either recurrent miscarriages or thromboembolic phenomena in the past. With no therapy there were seven (6.8%) live births and 95 (93.2%) failures. Various combinations of corticosteroids, anti-aggregants and anticoagulants were used for treatment. Of 52 treated pregnancies, 27 (51.9%) were successful. Sixteen (69.1%) of 23 pregnancies treated by all three modalities ended in live births. Four of these successful pregnancies occurred after failure of treatment by prednisone and anti-aggregants only. In order to minimize osteoporosis caused by the combination of steroids and heparin, we have used warfarin in the second trimester and have lately substituted low molecular weight heparin for heparin. In the absence of a therapeutic schedule predicated on a large prospective study, therapy during pregnancy in patients having LAC should be individualized according to their obstetric and medical history. Anticoagulants are indicated in patients who have suffered from thromboembolic phenomena and could be tried after failure of steroids and anti-aggregants.
- Subjects :
- Pediatrics
medicine.medical_specialty
medicine.drug_class
Immunology
Low molecular weight heparin
Azathioprine
Autoimmune Diseases
Pregnancy
Prednisone
medicine
Humans
Lupus Erythematosus, Systemic
Immunology and Allergy
Retrospective Studies
Lupus anticoagulant
Aspirin
Heparin
business.industry
Pregnancy Outcome
Warfarin
Anticoagulants
Obstetrics and Gynecology
Antiphospholipid Syndrome
medicine.disease
Thrombosis
Surgery
Pregnancy Complications
Treatment Outcome
Reproductive Medicine
Lupus Coagulation Inhibitor
Drug Therapy, Combination
Female
business
Platelet Aggregation Inhibitors
medicine.drug
Subjects
Details
- ISSN :
- 10467408
- Volume :
- 28
- Database :
- OpenAIRE
- Journal :
- American Journal of Reproductive Immunology
- Accession number :
- edsair.doi.dedup.....e59a61db60dbb16d338c587dbb3e7761