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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.
"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.
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