ABSTRACT
OBJECTIVE: To determine whether low molecular weight heparin (LMWH) plus low-dose aspirin (LDA) is comparable in efficacy and safety to unfractionated heparin (UFH) plus LDA in the management of pregnant women with a history of recurrent spontaneous abortion secondary to antiphospholipid syndrome (APS). METHODS: In a randomized prospective study, 60 women with a history of 3 or more consecutive spontaneous abortions and positive antiphospholipid antibodies were assigned in equal numbers to receive either UFH (5000 units, twice daily) plus LDA, or LMWH (enoxaparin 40 mg, once daily) plus LDA as soon as pregnancy was diagnosed. RESULTS: Twenty-four women in the LMWH group (80%) and 20 women in the UFH group (66.67%) delivered a viable infant (P = 0.243). There were no significant differences in pregnancy complications or neonatal morbidity between the 2 groups. There were no incidences of excessive bleeding, thrombocytopenia, or osteoporotic fractures in either group. CONCLUSION: LMWH plus LDA was successfully used as an alternative to UFH plus LDA in the management of recurrent abortion secondary to APS. The results highlight the need for a larger randomized controlled trial to determine whether LMWH plus LDA should be the treatment of choice for recurrent abortion secondary to APS. Clinicaltrials.gov NCT01051778.
Subject(s)
Abortion, Habitual/drug therapy , Anticoagulants/therapeutic use , Antiphospholipid Syndrome/complications , Aspirin/therapeutic use , Enoxaparin/therapeutic use , Heparin/therapeutic use , Platelet Aggregation Inhibitors/therapeutic use , Abortion, Habitual/etiology , Adult , Antibodies, Antiphospholipid/blood , Anticoagulants/adverse effects , Aspirin/adverse effects , Drug Therapy, Combination , Enoxaparin/adverse effects , Female , Hemorrhage/chemically induced , Heparin/adverse effects , Humans , Infant, Newborn , Osteoporotic Fractures/chemically induced , Pregnancy , Pregnancy Complications/chemically induced , Pregnancy Outcome , Thrombocytopenia/chemically induced , Treatment OutcomeABSTRACT
A 16-years-old Egyptian girl presented with massive pericardial effusion, fever, weight loss and hoarseness of voice. Laryngoscopy showed left vocal cord paralysis. Chest CT revealed pericardial effusion, amalgamated mediastinal lymph nodes and clear lung fields. Pericardial fluid analysis revealed a lymphocytic exudate with high adenosine deaminase enzyme level, negative stains and cultures for bacteria and fungi. Despite a negative nucleic acid test for tuberculosis; antituberculous and corticosteroids therapies resulted in resolution of pericardial effusion after 3 weeks but hoarseness of voice persisted. Few cases of vocal cord paralysis with tuberculous mediastinal lymphadenopathy were reported in English literature.
