Antiphospholipid Syndrome

Introduction

The antiphospholipid syndrome (APS) is characterized by the presence of specific autoantibodies in association with certain clinical conditions, most notably arterial and venous thrombosis and adverse pregnancy outcomes.

• Clinically, the diagnosis can be suspected after any of the following outcomes: an episode of thrombosis, three or more unexplained consecutive spontaneous abortions prior to 10 weeks gestation, one or more unexplained deaths of a morphologically normal fetus after 10 weeks ' gestation, or a preterm delivery at less than 34 weeks due to preeclampsia or placental insufficiency.
• In addition to these clinical features, laboratory criteria include the identification of at least one of the following three antiphospholipid antibodies:

1. Anticardiolipin antibodies,
2. Anti - beta - 2 - glycoprotein I antibodies, or
3. The lupus anticoagulant.

Management

• The optimal treatment for APS in pregnancy is unclear but generally, involves administration of a heparin compound and low dose aspirin.
• Inj- Heparin 5000-10,000 units S / C x BD OR
• Inj- Clexane (enoxaparin) 40mg S / C x OD
• Tab- Ascard (aspirin) 81 mg, 1 tablet PO X OD.
• Although anticoagulation is particularly prudent in women with a history of thrombosis, there is also evidence that this management reduces the risk for spontaneous abortion in women with recurrent pregnancy loss from APS.
• It is not clear whether continuation of therapy beyond the first trimester decreases the risk for stillbirth or placental dysfunction; however, treatment is typically continued through pregnancy and the early postpartum period for thromboprophylaxis.
• Either prophylactic or therapeutic dosing strategies may be appropriate depending on the patient's history and clinical risk factors.
• The use of corticosteroids and intravenous immunoglobulin is of unclear benefit in these patients, and neither treatment is recommended.