MANAGEMENT OF THROMBOSIS AND PREGNANCY LOSS IN THE ANTIPHOSPHOLIPID SYNDROME

More than a decade has gone by since the detailed clinical description of the Antiphospholipid (Hughes) Syndrome. Because of the wide spectr um of manifestations, virtually any physician may encounter patients w ith this potentially treatable condition. Because of limited controlle d, prospective data, current therapy remains empirical and directed at coagulation mechanisms, immune mechanisms, or both. There is now good evidence that patients with antiphospholipid-associated thrombosis wi ll be subject to recurrences and require prophylactic therapy. Althoug h most authorities agree about the efficacy of warfarin alone or warfa rin plus low-dose aspirin in preventing recurrences of venous and arte rial thrombosis, there is still doubt regarding the intensity and dura tion of warfarin therapy. Steroids and immunosuppressive drugs have no t provided longterm benefit. Controlled clinical trials of the treatme nt of pregnant women with antiphospholipid antibody demonstrated that prednisolone is ineffective, and possibly detrimental, in treatment of recurrent pregnancy loss and that heparin plus low-dose aspirin is be neficial.