Intravenous immunoglobulin therapy for the antiphospholipid syndrome.

Background. - The antiphospholipid syndrome was individualized 12 years ago . Treatment was initially based on steroids, immunosuppressive drugs and in travenous immunoglobulin therapy. More recently, several retrospective stud ies have established that in most clinical conditions therapeutic doses of oral vitamin K antagonists (INR greater than or equal to 3) are sufficient to control the disease. The role of immunoglobuline therapy. - However, high dose immunoglobulin th erapy is still indicated in a few cases, especially in life- threatening im mune peripheral thrombocytopenia, and in recurrent fetal loss: in the latte r indication, immunoglobulin therapy alone is efficient in 80% of cases. Future prospects. - Prospective studies are needed to assess the efficacy o f intravenous immunoglobulin therapy in neurological complications occurrin g in spite of anticoagulant therapy, and in the cor,text of repeated foetal losses when antithrombotic therapy with aspirin and subcutaneous heparin h as failed. (C) 1999 Elsevier, Paris.