scholarly journals The effect of low dose aspirin and low molecular weight heparin (enoxaparin) in recurrent pregnancy loss associated with antiphospholipid antibody syndrome

2017 ◽  
Vol 6 (11) ◽  
pp. 4830 ◽  
Author(s):  
Sasmita Swain ◽  
Sujata Singh
Keyword(s):  
Antiphospholipid Syndrome ◽  
Live Birth ◽  
Antiphospholipid Antibodies ◽  
Pregnancy Loss ◽  
Low Dose ◽  
Recurrent Pregnancy Loss ◽  
Antiphospholipid Antibody ◽  
Antiphospholipid Antibody Syndrome ◽  
Dose Aspirin ◽  
Low Dose Aspirin

Background: Recurrent miscarriage affects 1–2% of women. Recurrent pregnancy loss (RPL) is the loss of three or more consecutive pregnancies before or during the 20th week of gestation. The most important association between gestational loss and autoimmune phenomena is the presence of antiphospholipid antibodies represented by the lupus anticoagulants and or anticardiolipin antibodies (Antiphospholipid Antibody Syndrome). The antiphospholipid syndrome is an acquired autoimmune. The clinical features are thrombosis (venous, arterial and microvascular) and/or pregnancy complications; the most prominent of which is recurrent abortion.Methods: Twenty-two selected patients during pregnancy with clinical and/or serological findings of antiphospholipid syndrome had received low dose aspirin (75 mg once daily orally) plus LMWH enoxaparin (40 mg subcutaneously/day).Results: There are live born in 86% cases compared to abortion (< 20 weeks gestational age) in 14 % cases. From 19 liveborn babies the mother having normotensive in 79% and preeclampsia 21%, 85% babies having normal growth and 15% are IUGR. 36% cases are at term (>37 weeks) and 50% cases are at preterm (<37 week) on which 9%) is spontaneous preterm and 41% is iatrogenic preterm due to preeclampsia, IUGR, PPROM and APH.Conclusions: Use of low dose aspirin (75mg) and enoxaparin 40 mg subcutaneously daily in patients with RPL due to antiphospholipid syndrome resulted in higher live birth rates. Combination treatment with aspirin and LMWH leads to a high live birth rate among women with recurrent abortion and antiphospholipid antibodies. 

scholarly journals Comparison of empirical use of low dose aspirin and enoxaprin in the treatment of unexplained recurrent pregnancy loss

2020 ◽  
Vol 9 (3) ◽  
pp. 1138
Author(s):  
Sunil Kumar Juneja ◽  
Pooja Tandon ◽  
Gagandeep Kaur ◽  
Bakul Kapoor ◽  
Guneet Singh Sidhu
Keyword(s):  
Live Birth ◽  
Pregnancy Loss ◽  
Low Dose ◽  
Recurrent Pregnancy Loss ◽  
Chromosomal Anomalies ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Uterine Anomalies ◽  
Significant Difference ◽  
Recurrent Pregnancy Losses

Background: Recurrent pregnancy losses have commonly been defined as three or more consecutive spontaneous pregnancy losses. About 1-2% of women suffer from recurrent miscarriages. The cause is multifactorial such as uterine anomalies, endocrine disorders, immunological causes, infections, chromosomal anomalies and maternal autoimmune diseases. In 50-60% of cases recurrent pregnancy losses, the cause remains unclear. Objective of this study was to compare the maternal and fetal outcome in patients with unexplained recurrent pregnancy loss treated with LMWH (Enoxaparin) vs Aspirin during pregnancy.Methods: Women with 3 or more pregnancy losses, aged between 18-40 years, booked for antenatal care and delivery in our hospital between January 2012 and December 2016 were followed till 6 months after delivery.Results: A total number of 146 women were assessed for eligibility. We had 62 women in Group A (aspirin group) and 84 women in Group E (enoxaparin group). Enoxaparin was given to all those ladies who had taken aspirin in previous pregnancies with no live outcome. Good neonatal outcome was observed with Enoxaparin.Conclusions: Live birth rates did not show significant difference between the two study groups. But empirical use of enoxaparin in patients with no live birth who have taken low dose aspirin in previous pregnancy had shown improved results, so enoxaparin should be used empirically as a first line agent in such cases.

scholarly journals Successful Pregnancy Outcome in a Patient with Antiphospholipid Syndrome : A Case Report

2013 ◽  
Vol 3 (1) ◽  
pp. 44-46
Author(s):  
Hasna Fahmima Haque ◽  
Muhammad Abdur Rahim ◽  
Mohammad Gaffar Amin ◽  
Shahana Zaman ◽  
Pratik Dewan ◽  
...  
Keyword(s):  
Pregnancy Outcome ◽  
Antiphospholipid Syndrome ◽  
Pregnancy Loss ◽  
Low Dose ◽  
Recurrent Pregnancy Loss ◽  
Fetal Loss ◽  
Successful Pregnancy ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
High Index Of Suspicion

Antiphospholipid syndrome (APS) manifests clinically as recurrent venous or arterial thrombosis and/or fetal loss. Diagnosis requires a high index of suspicion during evaluation of women with recurrent pregnancy loss and vascular thrombosis. Low dose aspirin combined with heparin can reduce morbidity and improve the pregnancy outcome. Here we report a case of a 22 year old lady having APS who presented with arthritis, recurrent miscarriages and venous thrombosis. Birdem Med J 2013; 3(1): 44-46 DOI: http://dx.doi.org/10.3329/birdem.v3i1.17126

Prevention of Fetal Death in the Antiphospholipid Antibody Syndrome

Lupus ◽  
1996 ◽  
Vol 5 (5) ◽  
pp. 467-472 ◽  
Author(s):  
S Cowchock
Keyword(s):  
Pregnant Women ◽  
Live Birth ◽  
Low Dose ◽  
Fetal Death ◽  
Antiphospholipid Antibody ◽  
Antiphospholipid Antibody Syndrome ◽  
Live Birth Rates ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Plasma Heparin

The first treatment of pregnant women with antiphospholipid antibody syndrome (APLS) employed high doses of corticosteroids, plus low dose aspirin, with the goal of suppressing production of the autoantibody. Corticosteroids (usually prednisone), even when much lower doses are used, and even when tapered after midpregnancy, have been associated with significant maternal and obstetric risks and side effects: the most important are osteomalacia and preterm delivery (often precipitated by premature rupture of the membranes). Since the publication of a randomized trial demonstrating equivalent live birth rates of about 75% whether heparin or prednisone was used for treatment (plus low dose aspirin), the use of adjusted doses of heparin, together with low dose aspirin, has replaced prednisone for treatment of pregnant women; although prednisone may still be needed to treat manifestations of associated autoimmune disorders. A recent randomized trial has shown that the addition of heparin to aspirin is probably superior to treatment with aspirin alone. To achieve prophylactic levels of plasma heparin equivalent to those measured in patients who are not pregnant and are treated with the usual dose of standard heparin of 5000 IU every 12 h, the heparin dose required for treatment of pregnant women is usually higher. For that reason, heparin doses should be adjusted using the nadir APTT, or better plasma heparin measured by a factor Xa inhibition assay at the 2 h post-injection peak. Although low molecular weight heparin has been shown to be useful in prevention of fetal resorption in a mouse model, and appears to be equally safe for treatment of pregnant women, we still have no published data to show therapeutic equivalency, with respect to treatment of APLS-complicated pregnancy, to standard heparin preparations, and none that demonstrate any lower risk for the complication of most concern when heparin is given to pregnant women—osteopenia. Similarly, intravenous infusion of gamma globulins (IVG) appears on the basis of case reports to be effective additional treatment in cases where standard therapy has failed. Gamma globulin preparations contain anti-idiotypic antibodies that have been shown to bind to patient antiphospholipid antibodies. The place for the addition of IVG to standard therapy has not been defined, but clinically significant and corticosteroid-resistant thrombocytopenia complicating antiphospholipid antibody syndrome might be one indication for primary treatment with IVG ± low dose aspirin. Overall, live birth rates in most treatment studies are in the range of 70–80%. The reported birth rate information, however, cannot be compared between studies. None of the studies reported have used tools such as logistic regression analysis to allow for such significant predictors of live birth as the number of prior miscarriages, maternal age, medical history, or a history of fetal death (loss of a viable and chromosomally normal fetus after the 10th gestational week).

scholarly journals Digital ischaemia secondary to adalimumab-induced antiphospholipid syndrome

2020 ◽  
Vol 13 (2) ◽  
pp. e232907 ◽  
Author(s):  
Shashank Cheemalavagu ◽  
Sara S McCoy ◽  
Jason S Knight
Keyword(s):  
Antiphospholipid Syndrome ◽  
Low Dose ◽  
Antiphospholipid Antibody ◽  
Antibody Testing ◽  
Left Hand ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
History Of ◽  
Digital Ischaemia ◽  
Necrosis Factor

A 50-year-old woman with a history of Crohn’s disease treated with adalimumab presented with left hand pain and duskiness. Angiogram showed non-filling of the radial and digital arteries of the hand. Antiphospholipid antibody testing was positive, leading to a diagnosis of antitumour necrosis factor-induced antiphospholipid syndrome. Adalimumab was discontinued, and she was treated with the vitamin K antagonist warfarin and low-dose aspirin. Upon resolution of the antiphospholipid antibodies, she was transitioned to aspirin alone without recurrence of thrombosis.

scholarly journals Comparative study of low dose aspirin versus combination of low dose aspirin and low molecular weight heparin in idiopathic recurrent pregnancy loss

2020 ◽  
Vol 9 (2) ◽  
pp. 512
Author(s):  
S. Bhanu Rekha ◽  
K. Sharath Chandra
Keyword(s):  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Pregnancy Loss ◽  
Birth Rate ◽  
Low Dose ◽  
Recurrent Pregnancy Loss ◽  
Live Birth Rate ◽  
Low Molecular Weight ◽  
Dose Aspirin ◽  
Low Dose Aspirin

Background: To compare the role of low dose aspirin versus combination of low dose aspirin and low molecular weight heparin in idiopathic recurrent pregnancy loss and assess the effectiveness of low dose aspirin and low molecular weight heparin in having a better obstetric outcome.Methods: This study was conducted in a private hospital in Mahabubnagar from June 2017 to May 2019. A total of 80 pregnant ladies who had previous 2 and or more pregnancy losses in the early (before 20 weeks) or late (after 20 weeks) pregnancy period was included in the study. 80 pregnant women with idiopathic/unexplained recurrent pregnancy loss were properly evaluated in regard to the history of previous period of gestation of loss, previous scans in regard to documentation of fetal pole and gestation, cardiac activity, anomaly scan and growth scan and any special investigations in previous pregnancies and present pregnancy.Results: A total 80 pregnant women with previous 2 and more unexplained pregnancy losses who were evaluated and found negative with major causes of pregnancy losses half of them (40) were treated with low dose aspirin alone and the other 40 women were treated with a combination of low dose aspirin (75 mg) and low molecular weight Heparin (20 mg) daily low molecular weight heparin till term. The aspirin alone group had 82.5% live birth rate and the combination group had 92.5% live birth rate which is quite satisfactory and more than the Aspirin alone group.Conclusions: Use of combination of low dose aspirin and low molecular weight heparin seems to be a good choice of drugs in treating the unexplained recurrent pregnancy losses than low dose aspirin alone.

Stillbirth: the impact of antiphospholipid syndrome?

Lupus ◽  
2016 ◽  
Vol 26 (3) ◽  
pp. 237-239 ◽  
Author(s):  
C A Herrera ◽  
C C Heuser ◽  
D Ware Branch
Keyword(s):  
Antiphospholipid Syndrome ◽  
Antiphospholipid Antibodies ◽  
Lupus Anticoagulant ◽  
Low Dose ◽  
Fetal Death ◽  
Therapeutic Approaches ◽  
New Therapeutic Approaches ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
The Impact

Fetal death resulting in stillbirth is generally acknowledged as a feature of antiphospholipid syndrome. Recently published studies appear to confirm the association between antiphospholipid antibodies (aPL) and stillbirth, though additional studies of better design would be welcome. Emerging evidence suggests that treatment with heparin agents and low dose aspirin to prevent fetal death is imperfect. New therapeutic approaches for patients with lupus anticoagulant or triple aPL positivity are needed.

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