Do low-risk pregnant women with antiphospholipid antibodies need to be treated?☆,☆☆,★,★★
Section snippets
Methods
Pregnant women at low risk were defined as those who had zero to two spontaneous abortions, only one of which could have occurred after 12 weeks of pregnancy (fetal death). They also must have had no history of antiphospholipid antibody–related complications such as thrombosis, thrombocytopenia, or early-onset preeclampsia. Tests for immunoglobulin G or M anticardiolipin antibodies or lupus anticoagulants gave persistently positive results, as defined in the published trial.1 The patients were
Results
The patients' obstetric histories, pregnancy outcomes, and antiphospholipid antibody test results are summarized in Table I. None of the differences between groups was statistically significant (p < 0.05) according to Fisher's exact test.
Comment
The results suggested to us that women whose positive antiphospholipid antibody status is diagnosed almost incidentally (in these cases often because of a false-positive serologic test for syphilis) are not at high risk for antiphospholipid antibody–related obstetric complications. The prevalence of any complication in the control group was 13% (95% confidence interval 0.3% to 53%). Given this low frequency of complications, 384 pairs of similar women would need to be entered into a randomized
Acknowledgements
Members of the Organizing Group of the Antiphospholipid Antibody Treatment Trial are as follows: D. Ware Branch, MD, University of Utah, Salt Lake City, Utah; Donald Balaban, MD, and Susan Cowchock, MD, Jefferson Medical College, Philadelphia, Pennsylvania; and Leo Plouffe, MD, Medical College of Georgia, Augusta, Georgia.
References (2)
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Repeated fetal losses associated with antiphospholipid antibodies: a collaborative randomized trial comparing prednisone with low-dose heparin treatment
Am J Obstet Gynecol
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Comparative trial of prednisone plus aspirin versus aspirin alone in the treatment of anticardiolipin antibody–positive obstetric patients
Am J Obstet Gynecol
(1993)
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The treatment of anti-phospholipid syndrome: A comprehensive clinical approach
2018, Journal of AutoimmunityTreatment of Pregnancy Complications in Antiphospholipid Syndrome
2017, Handbook of Systemic Autoimmune DiseasesCitation Excerpt :No trials have directly compared aspirin with heparin or LMWH. As a single agent for the treatment of aPL-associated pregnancy complications, there are at least three randomized trials that have compared aspirin versus placebo or usual care in women with no previous thrombosis [60–62]. None found a benefit of aspirin, although the third study included women with recurrent spontaneous abortions with or without detectable aCL [61].
Antiphospholipid syndrome management: A 2023 update and practical algorithm-based approach
2023, Current Opinion in Rheumatology
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From the Jefferson Medical College of Thomas Jefferson University and the School of Medicine, Temple University. Members of the Organizing Group of the Antiphospholipid Antibody Treatment Trial are listed at the end of the article.
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Supported by National Institute of Child Health and Human Development grant 080-02154.
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Reprints not available from the authors.
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