Treatment Options in Refractory Obstetric Antiphospholipid Syndrome

Obstetric Antiphospholipid Syndrome (OAPS) is considered to be the cause of recurrent pregnancy loss (RPL) in 20% of cases. The mainstay of treatment for OAPS is low-dose aspirin (LDA) and heparin. In 20% of cases however, standard therapy will fail and additional treatment will be necessary. Increasing the heparin dosage, use of low-dose steroids, and hydroxychloroquine have been useful as add-on therapy. Other treatment options that are being explored are the following: intravenous immunoglobulin, plasma exchange, vitamin D, statins, anti-TNF, double anti-aggregant therapy, and pentoxifylline. Due to very few cases being treated, these treatment options are not yet well established and some are still controversial. Upcoming trials will hopefully shed more light to the usefulness of each of these add-on therapies for refractory OAPS.