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Treatment of pregnant patients with antiphospholipid syndrome

Rheumatology Allergy and Clinical Immunology, Brescia Hospital, Brescia, Italy

W Branch

Department of Obstetrics and Gynecology, University of Utah Health Science Center, Salt Lake City, Utah, USA

R A Levy

Discipline of Rheumatology, Faculdade de Ciencias Medicas, Universidade do Estado do Rio de Janeiro, Brazil

J C Piette

Department Internal Medicine, Hopital de la Pitié, Paris, France

H Carp

Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel

R S Rai

Department of Reproductive Science and Medicine, Imperial College School of Medicine at St Mary’s Mint Wing, London, UK

M Khamashta

Lupus Research Unit, Rayne Institute King’s College, St Thomas’ Hospital, London, UK

Y Shoenfeld

Center for Autoimmune Diseases, Internal Medicine ‘B’, Sheba Medical Center, Tel-Hashomer, Israel

Antiphospholipid Syndrome (APS) has been widely recognized as a risk factor for the recurrence of both thrombosis and pregnancy losses; however the optimal treatment of patients is debatable. The aim of this paper was to establish a consensus among experts on the treatment of APS in pregnancy. A questionnaire that described possible different clinical situations was sent to the International Advisory Board of the 10th International Congress on AntiphospholipidAntibodies. Sixteen experts from different medical branches and different geographic areas sent their replies. The consensus was that treatment for APS pregnant patients should be low molecular weight heparin (LMWH) and low dose aspirin (LDA). The dosage, and frequency of LMWH depends on different situations, including the body weight and past history. Patients with previous thromboses usually receive two injections per day. Warfarin can also be used from 14 to 34 weeks, for patients with previousstroke or severe arterial thromboses. The use of intravenous immunoglobulin (IVIG) seems to be restricted to patients with pregnancy losses despite conventional treatment. The experts usually advised barrier methods of contraception, intrauterine device (if the patient is not taking corticosteroids) or progestins. Oral contraception with oestrogens was usually avoided.

Key Words: antiphospholipid syndrome • pregnancy • thrombosis prophylaxis • treatment

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