PMID- 15307977
OWN - NLM
STAT- MEDLINE
DCOM- 20041116
LR  - 20220331
IS  - 1701-2163 (Print)
IS  - 1701-2163 (Linking)
VI  - 26
IP  - 8
DP  - 2004 Aug
TI  - Treatment of antiphospholipid antibody syndrome (APS) in pregnancy: a randomized 
      pilot trial comparing low molecular weight heparin to unfractionated heparin.
PG  - 729-34
AB  - OBJECTIVE: To compare low molecular weight heparin (LMWH), specifically 
      dalteparin, to unfractionated heparin (UFH) for the treatment of antiphospholipid 
      antibody syndrome (APS) in pregnancy. METHODS: In a tertiary referral centre, 28 
      women met the 1999 International Consensus Criteria for APS, based on their 
      obstetrical history and APS serology. The women were randomized, using a random 
      numbers table with blocks of 12, to receive either prophylactic dosing of 
      dalteparin or UFH starting either preconceptionally or early in pregnancy. All 
      women also received low-dose acetylsalicylic acid, started preconceptionally. The 
      primary outcome was a live birth. The secondary outcomes were maternal and fetal 
      complications. RESULTS: Of the 14 women who received the LMWH, dalteparin, and 
      the 14 women who received UFH, 1 woman in each group did not conceive. Nine of 
      the 13 women (69%) given dalteparin had a successful pregnancy (95% confidence 
      interval [CI], 39-91%), compared to 4 out of the 13 women (31%) in the UFH group 
      (95% CI, 9-61%). Nine women in total had spinal or epidural anaesthesia, and 
      there were no complications overall. CONCLUSION: Dalteparin may be an effective 
      alternative to UFH for treatment of APS in pregnancy. A multicentre randomized 
      trial is needed to determine benefit-to-risk ratios for the use of dalteparin and 
      UFH to treat this high-risk obstetrical condition. Pharmacokinetic and 
      pharmacodynamic studies are also recommended to maximize therapeutic response and 
      minimize toxicity.
FAU - Stephenson, Mary D
AU  - Stephenson MD
AD  - Department of Obstetrics and Gynaecology, University of British 
      Columbia,Vancouver.
FAU - Ballem, Penny J
AU  - Ballem PJ
FAU - Tsang, Peter
AU  - Tsang P
FAU - Purkiss, Sue
AU  - Purkiss S
FAU - Ensworth, Stephanie
AU  - Ensworth S
FAU - Houlihan, Edwina
AU  - Houlihan E
FAU - Ensom, Mary H H
AU  - Ensom MH
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - Netherlands
TA  - J Obstet Gynaecol Can
JT  - Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et 
      gynecologie du Canada : JOGC
JID - 101126664
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
RN  - R16CO5Y76E (Aspirin)
RN  - S79O08V79F (Dalteparin)
SB  - IM
MH  - Adult
MH  - Anticoagulants/*therapeutic use
MH  - Antiphospholipid Syndrome/*drug therapy
MH  - Aspirin/therapeutic use
MH  - Dalteparin/*therapeutic use
MH  - Female
MH  - Heparin/*therapeutic use
MH  - Humans
MH  - Pilot Projects
MH  - Preconception Care
MH  - Pregnancy
MH  - Pregnancy Complications/*drug therapy
MH  - Pregnancy Outcome
EDAT- 2004/08/17 10:00
MHDA- 2004/11/17 09:00
CRDT- 2004/08/17 10:00
PHST- 2004/08/17 10:00 [pubmed]
PHST- 2004/11/17 09:00 [medline]
PHST- 2004/08/17 10:00 [entrez]
AID - S1701-2163(16)30644-2 [pii]
AID - 10.1016/s1701-2163(16)30644-2 [doi]
PST - ppublish
SO  - J Obstet Gynaecol Can. 2004 Aug;26(8):729-34. doi: 10.1016/s1701-2163(16)30644-2.