In a patient with Anti-Phospholipid Antibody syndrome, which of the following treatment is used to prevent further abortions?
Correct Answer: Aspirin + LMWH
Description: Ans. a. Aspirin + LMWH (Ref: Harrison 19/e p2134. 18/e p2737)Aspirin and low molecular weight heparin (LMWH) is used to prevent further abortions in patients of Anti-Phospholipid Antibody syndrome.'After the first thrombotic event, APS patients should be placed on warfarin for life aiming to achieve an international normalized ratio (TNR) ranging from 2.5 to 3.5, alone or in combination with 80 mg of aspirin daily. Pregnancy morbidity is prevented by a combination of heparin with aspirin 80 mg daily. Intravenous immunoglobulin (IVIg) 400 mg/kg qdfor 5 days may also prevent abortions, while glucocorticoids are ineffective. - Harrison 18/e p2737Antiphospholipid Antibody Syndrome (APS)Defined by a clinical association of antiphospholipid antibodies and hypercoagulabilityQConsidered a systemic autoimmune disease which is characterized by recurrent thrombosis or pregnancy complications, along with the presence of Antiphospholipid antibodiesQPrimary APS: No cause is identified; Secondary APS: Defined cause like SLE is identifiedClinical Features:Vascular ThrombosisPregnancy MorbidityVenous thrombosis (More common)* Recurrent arterial or venous thrombosis in any tissue or organ is the most common presentationQ* Recurrent spontaneous abortionsQ* Pregnancy induced hypertensionQ (Preeclampsia and eclampsia)* Placental Insufficiency/ AbruptionQ* Intrauterine Growth RetardationQ* DVT is the MC manifestationQ* Pulmonary EmbolismQ* Pulmonary hypertension from thromboembolic disease Arterial thromobosis (less common)CNSHeartLungsKidneyBonesStrokeQ (Cerebral vessel occlusion)Myocardial infarctionQ (coronary occlusion)Pulmonary hypertensionQ(Pulmonary artery occlusion)Glomerular thrombosisQRenal artery thrombosisQAvascular necrosis Antiphospholipid Antibody Syndrome (APS): Laboratory Features* Elevated Anticardiolepin antibodiesQ (IgG or lgM)Q* Elevated Anti b-2 glycoprotein-1 AntibodyQ* ThrombocytopeniaQ* Presence of Lupus Anticoagulant (LA) in plasmaQ* Hemolytic anemiaQ (Coomb's positive)Evan's syndrome refers to the clinical association of autoimmune thrombocytopenia and autoimmune hemolytic anemiaQ.Evan's syndrome has been reported in 10% of patients with Antiphospholipid syndromeTreatment:The mainstay of treatment of Antiphospholipid Syndrome is WarfarinQ.After the first thrombotic event, APS patients should be placed on warfarin for life aiming to achieve an international normalized ratio (INR) ranging from 2.5 to 3.5, alone or in combination with 80 mg of aspirin daily.Pregnancy morbidity is prevented by a combination of heparin with aspirin 80 mg daily.Intravenous immunoglobulin (IVIg) 400 mg/kg qd for 5 days may also prevent abortions, while glucocorticoids are ineffectiveQ.
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