Antiphospholipid antibody–associated recurrent pregnancy loss: Treatment with heparin and low-dose aspirin is superior to low-dose aspirin alone,☆☆,

Presented at the Forty-second Annual Meeting of The American College of Obstetricians and Gynecologists, Orlando, Florida, May 9-12, 1994.
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Abstract

OBJECTIVE: The purpose of this study was to compare the use of low-dose aspirin alone with heparin and low-dose aspirin in the treatment of the antiphospholipid antibody syndrome. STUDY DESIGN: A prospective, single-center trial included 50 patients who were alternately assigned to treatment. Each patient had at least three consecutive spontaneous pregnancy losses, positive antiphospholipid antibodies on two occasions, and a complete evaluation. Data were compared by χ2 analysis and Fisher's exact test. RESULTS: Viable infants were delivered of 11 of 25 (44%) women treated with aspirin and 20 of 25 (80%) women treated with heparin and aspirin (p < 0.05). There were no significant differences between the low-dose aspirin and the heparin plus low-dose aspirin groups with respect to gestational age at delivery (37.8 ± 2.1 vs 37.2 ± 3.4 weeks), number of cesarean sections (18% vs 20%), or complications. CONCLUSION: Heparin plus low-dose aspirin provides a significantly better pregnancy outcome than low-dose aspirin alone does for antiphospholipid antibody–associated recurrent pregnancy loss. (AM J OBSTET GYNECOL 1996;174:1584-9.)

Section snippets

Subjects

All women were patients at the Southwestern Fertility Associates of the University of Texas Southwestern Medical Center. More than 600 women with recurrent pregnancy loss were evaluated before 50 women with the APA syndrome who consented to participate in this study were identified. This diagnosis was based on a well-documented history of at least three spontaneous consecutive miscarriages and APA levels that were ≥27 IgG or ≥23 IgM phospholipid units (>2.5 multiples of the median) on two

Patient population

Fifty women with the APA syndrome were sequentially assigned to treatment with aspirin alone or with heparin plus aspirin after a confirmed pregnancy test. As shown in Table I, there were no significant differences in the patient age at entry, total number of prior pregnancies, prior live births or miscarriages, gestational age at loss, or percentage of losses that occurred before 12 weeks, between 13 to 19 weeks, or after 20 weeks of gestation. Each woman had an APA level of at least 27

COMMENT

Recurrent pregnancy loss, defined as three or more spontaneous consecutive abortions, affects approximately 1% to 2% of reproductive-aged women in the United States.1 Various causes of recurrent pregnancy loss include genetic, anatomic, endocrinologic, immunologic, microbiologic, and as yet unknown factors. Of the immunologic causes, several investigators have correlated increased levels of APAs and the presence of lupus anticoagulant with increased obstetric complications including IUGR,

Acknowledgements

I thank the following physicians who helped care for patients during their pregnancies: A. Ahmed, J. Arias, B. Axmann, S. Bakos, K. Bradshaw, M. Cane, J. Cornwell, B. Crockett, U. Crosby, M. Davis, K.M. Doody, J. Dorsett, R. Dowling, C. Edman, J. Gilbertson, J. Goss, A. Guerami, S. Hoffman, E. Hunt, A. Johns, J. Kapsos, C. Kinney, C. Kutteh, W. Maxwell, T. Neel, J. Nelson, M. Read, R. Reinmund, K. Reisler, E. Silverstein, B. Stettler, S. Stone, L. Tatum, G. Theilen, K. Trimmer, L. Umholtz, M.

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From the Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center at Dallas.

☆☆

Reprint requests: William H. Kutteh, MD, PhD, Division of Reproductive Immunology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75235-9032.

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