Аспирин бесполезен, если есть АФЛ-антитела, но нет клин. диагноза АФС

[Dr.Vad]

Недавнее ретроспективное исследование показало, что риск невынашивания при наличии только антифосфолипидных антител БЕЗ клинических данных, указывающих на антифосфолипидный синдром, очень низкий ~5 % и назначение аспирина таким женщинам не повышает шансы на вынашивание (в группе, принимающей аспирин, наоборот частота невынашивания была в 2 раза выше).

J Rheumatol. 2013 Apr;40(4):425-9.
Treatment of 139 Pregnancies in Antiphospholipid-positive Women Not Fulfilling Criteria for Antiphospholipid Syndrome: A Retrospective Study.
Del Ross T, Ruffatti A, Visentin MS, Tonello M, Calligaro A, Favaro M, Hoxha A, Punzi L.
From the Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy.

OBJECTIVE: The effect of low-dose aspirin (LDA) on pregnancy outcome in antiphospholipid (aPL)-positive women not fulfilling the criteria for antiphospholipid antibody syndrome (APS) was evaluated retrospectively.

METHODS: We evaluated 139 pregnancies of 114 aPL-positive women not fulfilling the Sydney classification criteria for definite APS (104 treated with LDA, 35 untreated). Inclusion criteria consisted of (1) any titer of aPL and no previous pregnancy or no pregnancy losses (defined as aPL carriers); (2) any titer of aPL and 1 or 2 pregnancy losses before the 10th gestational week. No women had previous thrombosis. The rate of pregnancy loss, gestational age at delivery, and birth weight percentile were compared in the treated and untreated patients. Associations between clinical and laboratory characteristics and pregnancy outcomes were investigated.

RESULTS: The rate of pregnancy loss was low in both treated and untreated groups (7.7% vs 2.9%, respectively). There were no statistically significant differences in the rate of pregnancy loss, gestational age at birth, or birth weight percentile in the treated and untreated groups...

CONCLUSION: LDA treatment does not appear to improve pregnancy outcome in low-risk women not fulfilling the criteria for APS.

[Dr.Vad]

Японцы в своем обзоре уже опубликованных клинических данных тоже пришли к такому же выводу - назначение аспирина только при лаб. выявлении антифосфолипидных антител НЕ повышает шансов на донашивание и не снижает риск осложнений при беременности:

Data from five studies involving 154 pregnancies were included and three studies were meta-analysed. The risk ratio and 95% confidence interval (CI) of live birth rates, preterm birth, low birth weight and overall pregnancy complications in treated and untreated pregnancies were 1.14 (0.18-7.31); 1.71 (0.32-8.98); 0.98 (0.07-13.54) and 2.15 (0.63-7.33),respectively. Results from the meta-analysis revealed that prophylactic treatment with aspirin is not superior to placebo to prevent pregnancy complications in asymptomatic aPL carriers.

Lupus. 2015 Mar 25. Primary prophylaxis to prevent obstetric complications in asymptomatic women with antiphospholipid antibodies: a systematic review.
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