Is there a Role for Antithrombotic Therapy in the Prevention of Pregnancy Loss?

Abstract

The antiphospholipid syndrome (APS) is now emerging as an important cause of recurrent pregnancy loss. A variety of treatments, including steroids, aspirin, heparin and immunoglobulin, alone or in combination, have been assessed in experimental studies and in clinical trials. Steroids are no longer recommended as first-line therapy for patients with APS without overt lupus, because they are associated with significant foetal and maternal morbidity. Based on data from recent trials, heparin plus low-dose aspirin appears to be the regimen of choice for patients with APS who have a history of thrombosis or pregnancy losses with aspirin alone. Aspirin is safe in pregnancy. Subcutaneous heparin does not cross the placenta and therefore has no adverse effects on the foetus. For the mother, however, potential side effects of heparin treatment include bleeding, thrombocytopenia and osteoporosis. Warfarin must be avoided during the first trimester but may have a role to play subsequently in certain subsets of patients. Some studies have demonstrated that combined therapy with prednisone and aspirin, or with heparin and aspirin, may improve the outcome in women with autoimmune disorders who are undergoing in-vitro fertilization.

Thrombotic thrombocytopenic purpura and pregnancy: a case report and a review of the literature

“…Considering the presence of multifactorial and complex thrombotic risk and the previous history of TTP, a prophylactic treatment with aspirin and low-molecular-weight heparin (LMWH) was started. Before delivery, aspirin was discontinued and completely replaced by heparin, which does not cross the placenta and therefore has no adverse effects on the fetus [15,16].…”

Das Antiphospholipidsyndrom Pathogenese, molekulare Grundlagen und klinische Aspekte

“…Empfohlen wird eine tägliche Aspiringabe (75 mg) ab dem Zeitpunkt der Feststellung der Schwangerschaft. Die Heparingabe (5000 Einheiten subkutan alle 12 Stunden) sollte einsetzen, sobald im Ultra- ÜBERSICHT schall eine fetale Herztätigkeit nachgewiesen ist [9,126]. Heparin wird subkutan eingesetzt, da es dann nicht plazentagängig ist.…”