Ichikawa Tomoko, Watanabe Takami, Kubota Yumene, Matsuda Shigeru, Shigemi Daisuke, Kasano Sayuri, Yokote Ryoko, Yonezawa Mirei, Ouchi Nozomi, Negishi Yasuyuki, Kuwabara Yoshimitsu, Takeshita Toshiyuki, Suzuki Shunji
Department of Obstetrics and Gynecology Nippon Medical School Tokyo Japan.
Department of Microbiology and Immunology Nippon Medical School Tokyo Japan.
Reprod Med Biol. 2025 Mar 26;24(1):e12643. doi: 10.1002/rmb2.12643. eCollection 2025 Jan-Dec.
Heparin and aspirin (HA) therapy is used for antiphospholipid syndrome (APS)-associated recurrent pregnancy loss (RPL). Low-dose aspirin (LDA) is recommended for thrombophilic predispositions, such as antiphospholipid antibodies that do not completely meet the Sydney classification criteria for APS, protein S deficiency, factor XII deficiency and increased platelet aggregation. However, no established strategy exists for cases where LDA is ineffective. Therefore, this study aimed to identify the characteristics of RPL cases unresponsive to LDA and to determine whether HA is more effective than LDA in such cases.
A total of 913 LDA-treated pregnancies were categorized into live births and miscarriages, and their characteristics were retrospectively analyzed.
The live birth rates following one, two, or three or more LDA therapies were 78.5%, 61.5% and 16.7%, respectively. Live birth rates were significantly lower when lupus anticoagulant (LAC) aPTT was positive but did not qualify as obstetric APS following LDA therapy (birth rates: 33.3%, = 0.048). Three or more LDA therapies decreased the live birth rate, whereas HA therapy significantly increased the live birth rate ( = 0.0019).
HA therapy is recommended over repeated LDA treatment, particularly when LAC aPTT is positive but does not qualify as obstetric APS.
肝素与阿司匹林（HA）疗法用于抗磷脂综合征（APS）相关的复发性流产（RPL）。对于血栓形成倾向，如不完全符合APS悉尼分类标准的抗磷脂抗体、蛋白S缺乏、因子XII缺乏及血小板聚集增加，推荐使用低剂量阿司匹林（LDA）。然而，对于LDA无效的病例，尚无既定策略。因此，本研究旨在确定对LDA无反应的RPL病例的特征，并确定在此类病例中HA是否比LDA更有效。
将913例接受LDA治疗的妊娠分为活产和流产，并对其特征进行回顾性分析。
接受一次、两次或三次及以上LDA治疗后的活产率分别为78.5%、61.5%和16.7%。当狼疮抗凝物（LAC）活化部分凝血活酶时间（aPTT）为阳性但在LDA治疗后不符合产科APS标准时，活产率显著降低（活产率：33.3%，P = 0.048）。三次及以上LDA治疗降低了活产率，而HA治疗显著提高了活产率（P = 0.0019）。
推荐使用HA疗法而非重复LDA治疗，尤其是当LAC aPTT为阳性但不符合产科APS标准时。
