Improving the Treatment of Antiphospholipid Syndrome in Pregnant Women: Results of A Clinical Study
Abstract
Background: Antiphospholipid syndrome (APS) in pregnancy is a complex and clinically important problem. The venous and arterial thromboses characteristic of the syndrome, caused by circulating antiphospholipid antibodies, lead to a range of pregnancy complications and adverse outcomes, which calls for improved treatment strategies.
Objective: to optimize the treatment of antiphospholipid syndrome in pregnant women.
Materials and Methods: The study included 56 pregnant women with APS, who were divided into two groups. The groups were comparable in age, parity, and obstetric and somatic pathology but differed in the treatment received. The comparison group (conventional management) comprised 18 pregnant women with APS, all of whom received standard APS therapy, including anticoagulants, antiplatelet agents, and glucocorticoids. The main group comprised 38 pregnant women with APS, all of whom received systemic enzyme therapy and plasmapheresis in addition to standard therapy. A separate control group consisted of 30 women with uncomplicated pregnancies.
Results: After 30 days, the conventional therapy group showed elevations compared with controls in von Willebrand factor (by 17.7%), the platelet aggregation index (by 24.1%), the total platelet aggregation index (by 26.2%), soluble fibrin monomer complexes (SFMC; by 55.3%), and early fibrin degradation products (EFDP; by 45.6%) (p<0.05). The platelet disaggregation index decreased by 18.5% and antithrombin III activity by 14.3% (p>0.05). Under conventional therapy, hemostatic parameters changed in different directions during treatment; overall, however, these changes aggravated the disturbances present at baseline. In the main group, treatment produced a more pronounced shift toward normalization of the studied parameters. Significant differences from conventional therapy were found for SFMC (29.7%), EFDP (23.3%), and prothrombin time (14.0%) (p<0.05).
Conclusion: Systemic enzyme therapy combined with plasmapheresis and low-molecular-weight heparin in pregnant women with APS results in near-complete normalization of hemostatic parameters.
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References
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