title: Adjusted prophylactic doses of nadroparin plus low dose aspirin therapy in obstetric antiphospholipid syndrome. A prospective cohort management study.
abstract: OBJECTIVE
  Current guidelines for the treatment of patients with obstetric antiphospholipid syndrome (APS) recommend low dose aspirin (LDA) and prophylactic doses of low molecular weight heparin (LMWH). Most clinicians use a fixed dosage of LMWH in pregnant APS women despite the fact that there are no clinical trials establishing that fixed doses are more efficacious than adjusted ones in preventing pregnancy complications. The efficacy and safety of adjusted single daily doses of LMWH (nadroparin) combined with LDA have thus been evaluated in 33 consecutive pregnancies in women with diagnosed obstetric APS.
  
  
  METHODS
  LMWH doses were augmented as the pregnancies progressed and maternal/foetal weight increased. 70-80-90 U/Kg doses ranging between 3800 and 6650 U were administered daily during the first, second and third trimesters, respectively. LDA (100 mg/day) was also prescribed.
  
  
  RESULTS
  Pregnancy outcome was successful in 97% of the patients studied, who delivered, between the 29th and 41st weeks of gestation (mean 37.4 ±2.1 SD), 32 infants with a mean birth weight of 3084 g ± 514 SD. One woman (3%) experienced a spontaneous abortion at the 8th week of gestation.
  
  
  CONCLUSIONS
  The high live birth rate, the satisfactory mean gestational age and weight at birth and the absence of major pregnancy/neonatal-associated complications indicate that adjusted, once daily doses of LMWH together with LDA could be an efficacious treatment option for pregnant APS patients with no history of thrombosis.
authors.affiliation: Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy. amelia.ruffatti@unipd.it
authors.forename: A
authors.initials: A
authors.lastname: Ruffatti
authors.forename: M T
authors.initials: MT
authors.lastname: Gervasi
authors.forename: M
authors.initials: M
authors.lastname: Favaro
authors.forename: A T
authors.initials: AT
authors.lastname: Ruffatti
authors.forename: A
authors.initials: A
authors.lastname: Hoxha
authors.forename: L
authors.initials: L
authors.lastname: Punzi
mesh_terms: D000022:Abortion, Spontaneous / Q000517:prevention & control*; D000328:Adult; D016736:Antiphospholipid Syndrome / Q000188:drug therapy*; D001241:Aspirin / Q000627:therapeutic use*; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005865:Gestational Age; D006801:Humans; D050498:Live Birth; D017762:Nadroparin / Q000627:therapeutic use*; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000517:prevention & control*; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012189:Retrospective Studies
chemical_list: D005343:Fibrinolytic Agents; D017762:Nadroparin; D001241:Aspirin