Thromb Haemost 2020; 120(01): 036-043
DOI: 10.1055/s-0039-1697665
Coagulation and Fibrinolysis
Georg Thieme Verlag KG Stuttgart · New York

Upgrading Therapy Strategy Improves Pregnancy Outcome in Antiphospholipid Syndrome: A Cohort Management Study

Ariela Hoxha*
1  Department of Medicine-DIMED, Rheumatology Unit, University of Padua, Padua, Italy
2  Department of Medicine, Internal Medicine Unit, San Bortolo Hospital, Vicenza, Italy
,
Maria Favaro*
1  Department of Medicine-DIMED, Rheumatology Unit, University of Padua, Padua, Italy
,
Antonia Calligaro
1  Department of Medicine-DIMED, Rheumatology Unit, University of Padua, Padua, Italy
,
Teresa Del Ross
1  Department of Medicine-DIMED, Rheumatology Unit, University of Padua, Padua, Italy
,
Alessandra Teresa Ruffatti
3  Obstetrics and Gynaecology Unit, University Hospital Padua, Padua, Italy
,
Chiara Infantolino
3  Obstetrics and Gynaecology Unit, University Hospital Padua, Padua, Italy
,
Marta Tonello
1  Department of Medicine-DIMED, Rheumatology Unit, University of Padua, Padua, Italy
,
Elena Mattia
1  Department of Medicine-DIMED, Rheumatology Unit, University of Padua, Padua, Italy
,
Amelia Ruffatti
1  Department of Medicine-DIMED, Rheumatology Unit, University of Padua, Padua, Italy
› Author Affiliations
Funding None.
Further Information

Publication History

10 December 2018

16 August 2019

Publication Date:
21 October 2019 (online)

Abstract

The current study evaluates the efficacy and safety of different treatment strategies for pregnant patients with antiphospholipid syndrome. One hundred twenty-seven consecutive pregnancies were assessed; 87 (68.5%) with a history of pregnancy morbidity alone were treated with prophylactic low molecular weight heparin (LMWH) + low-dose aspirin (LDA, 100 mg) (group I) and 40 (31.5%) with a history of thrombosis and/or severe pregnancy complications with therapeutic LMWH + LDA (group II). LMWH doses were increased throughout the pregnancies depending on the patients' weight gain, and treatment was switched to a more intensive one at the first sign of maternal/fetal complications. The study's primary outcome was live births. There were no significant differences in live birth rate between group I (95.4%) and group II (87.5%). Even fetal complication rate was similar in the two groups; group II nevertheless had a higher prevalence of maternal and neonatal complications (p = 0.0005 and p = 0.01, respectively) and registered a significantly lower gestational age at delivery and birth weight (p = 0.0001 and p = 0.0005, respectively). Two patients in group I switched to group II therapy, six patients in group II switched to a more intensive treatment strategy (weekly plasma exchange + fortnightly intravenous immunoglobulins in addition to therapeutic LMWH + LDA). The multivariate analysis uncovered that triple antiphospholipid antibodies positivity was an independent factor leading to a more intensive therapy. All eight switched patients achieved a live birth. Study results revealed that adjusted LMWH doses and switching therapy at first signs of severe pregnancy complications led to a high rate of live births in antiphospholipid syndrome patients.

Ethical Approval

The Institutional Review Board for observational studies and the Audit Committee of the University-Hospital of Padua approved the study protocol (Protocol Number: 6894/2013, February 7, 2013).


* The first two authors contributed equally to the study.