Do low-risk pregnant women with antiphospholipid antibodies need to be treated?

VTE, Thrombophilia, Antithrombotic Therapy, and Pregnancy

“…The use of higher-dose UFH and aspirin did not decrease the risk of pregnancy loss compared with low-dose UFH and aspirin (one trial, n 5 50; RR, 0.83; 95% CI, 0.29-2.38). 252,280 On its own, aspirin (three trials, n 5 71) failed to demonstrate or exclude an effect on pregnancy loss compared with usual care 281 or placebo 282,283 (RR, 1.05; 95% CI, 0.66-1.68). 252 In one trial, the combination of LMWH with aspirin had also failed to demonstrate or exclude an effect on pregnancy loss when compared with Successful pregnancy outcome depends on trophoblast invasion into the uterine vasculature and on the development and maintenance of an adequate uteroplacental circulatory system.…”

“…252,284 Similar results were obtained when LMWH and aspirin was compared with IV g -globulin (RR, 0.37; 95% CI, 0.12-1.16). 252,281 A subsequent meta-analysis that combined data from randomized trials testing the effi cacy of a combination of heparin (either UFH or LMWH) and aspirin vs aspirin alone in patients with APLAs and recurrent pregnancy loss 292 included an additional LMWH study published since the fi rst systematic review. 293 When data from fi ve trials (n 5 334) were combined, the frequency of live births was significantly higher in the aspirin and heparin group (74.3%) than in those randomized to aspirin alone (55.8%) (RR, 1.3; 95% CI, 1.0-1.7; NNT to achieve one live birth, 5.6).…”

Update on the management of the pregnant patient with antiphospholipid antibody

“…Premature closure of the ductus arteriosus is a theoretical concern in infants of women treated with aspirin but has not been documented with low-dose aspirin. A controlled trial of low-dose aspirin versus usual obstetric care in 19 asymptomatic aPL-positive women with zero or one early spontaneous abortion did not show benefit of aspirin [40]; however, the number of patients was small.…”

Management of the antiphospholipid syndrome

“…Two studies, a double-blind randomized placebo-controlled trial [75] and a subgroup analysis of one randomized controlled trial performed by Cowchock and Reece [76], have not shown any benefit of adding aspirin to an intensive obstetric care and placebo treatment. The prognosis in both the aspirin and control groups was remarkably good, with success rates over 80%.…”

“…The prognosis in both the aspirin and control groups was remarkably good, with success rates over 80%. However, most patients included in these studies had only low-titre aCL [75] or a lack of significant adverse obstetric histories [76]. In addition, treatment was started when pregnancy was diagnosed or on discovery of aPL during pregnancy, but not before conception.…”