Suppression of the aPL with vigorous immunosuppression has largely been reserved for patients who have responded inadequately to anticoagulation alone . For patients with aPL and recurrent thrombosis, the risk of additional subsequent events is very high. For the patient who has experienced a single thrombotic event, treatment is less clear. However, most clinicians favor treatment for patients with moderate or higher antibody titers and a single thrombotic event. Fetal Loss With treatment, nearly 75 per cent of patient with aPL and recurrent fetal loss will deliver a viable infant.
Limited data indicate that treatment with either heparin or prednisone is equally efficacious.
Presently, a number of experienced clinicians favor treatment with heparin because of a lower incidence of side effects. Treatment is begun as soon as a viable pregnancy is diagnosed, usually at 5-6 weeks' gestation, and continued for the duration of the pregnancy. Treatment with prednisone or intravenous gamma globulin is reserved for patients in whom heparin therapy has been ineffective, although some studies have demonstrated no beneficial effect with such therapies. In patients with aPL who do not have a history of fetal loss or who may have a history of an early spontaneous abortion, low-dose ASA alone is often used. Catastrophic APS A combination of plasmapheresis and anticoagulation is generally the treatment of choice when immunosuppressive therapy, including high dose and pulse corticosteroids, is generally ineffective.