Department of Obstetrics and Gynecology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan.
Obstetrics & Gynecology Katano Clinic, Kasugai, Japan.
Mod Rheumatol. 2020 Mar;30(2):332-337. doi: 10.1080/14397595.2019.1602241. Epub 2019 Apr 24.
The objective is to evaluate whether danaparoid is effective in improving the live birth rate in patients with obstetric antiphospholipid syndrome (oAPS). This prospective study included 91 pregnancies of 60 patients with oAPS diagnosed according to criteria of the International Congress on APS. Live birth rates, adverse pregnancies and perinatal outcomes were compared among patients treated with danaparoid and low dose aspirin (danaparoid group, LDA), unfractionated heparin (UFH) and LDA (UFH group) and LDA and/or prednisolone (LDA group). After excluding 11 miscarriages with abnormal embryonic chromosomes, one chemical pregnancy and one ectopic pregnancy, live birth rates were 87.5% (14/16) for the danaparoid group, 90.0% (36/40) for the UFH group and 63.6% (14/22) for the LDA group, respectively. The live birth rates of patients treated with danaparoid and UFH were similar and tended to be higher than that of patients treated with LDA, respectively (OR 4.0, 95% confidence interval 0.72-22.22 and 5.15, 1.33-20.00). No patient given danaparoid and one patient with UFH developed heparin-induced thrombocytopenia which resulted in a stillbirth. Another patient with UFH suffered a lumbar compression fracture. Danaparoid is effective for improving the live birth rate and is safe for patients with oAPS.
目的是评估达那肝素是否能提高产科抗磷脂综合征（oAPS）患者的活产率。这项前瞻性研究纳入了 60 例根据 APS 国际会议标准诊断为 oAPS 的患者的 91 例妊娠。比较了达那肝素联合低剂量阿司匹林（达那肝素组）、未分级肝素（UFH）联合低剂量阿司匹林（UFH 组）以及低剂量阿司匹林和/或泼尼松龙（LDA 组）治疗的患者的活产率、不良妊娠和围产期结局。在排除 11 例胚胎染色体异常的流产、1 例生化妊娠和 1 例异位妊娠后，达那肝素组的活产率为 87.5%（14/16），UFH 组为 90.0%（36/40），LDA 组为 63.6%（14/22）。达那肝素联合 UFH 治疗的患者活产率相似，且分别高于 LDA 治疗的患者（OR 4.0，95%置信区间 0.72-22.22 和 5.15，1.33-20.00）。未给予达那肝素的患者和 1 例给予 UFH 的患者发生肝素诱导的血小板减少症，导致死胎。另 1 例 UFH 患者发生腰椎压缩性骨折。达那肝素可有效提高 oAPS 患者的活产率，且安全。
