Abstract Number: PB2563
Meeting: ISTH 2020 Congress
Background: Antiphospholipid syndrome (APS) is a severe acquired thrombophilia abnormality associated with an increased risk of thrombosis, recurrent miscarriage and late complications. The combined use of low-dose aspirin and low-molecular-weight heparin usually improves pregnancy outcome, but in 30% of women with obstetric APS is unsuccessful.
Results: An Egyptian 32-year-old obese (BMI 37.5) woman with triple APA at a high titer and homozygous factor V Leiden had recurrent deep vein thrombosis of the lower limbs since the age of 13 years and two early miscarriages at the age of 25 and 29 years. She arrived in Italy at the age of 30 years and referred to our Center during her third pregnancy. Since the first weeks she started enoxaparin 8,000 IU bid (body weight 102 kg), aspirin 100 mg od, intravenous immunoglobulins 400 mcg/kg for 5 days monthly and prednisone 1 mg/kg od. At week 26 she developed preeclampsia and fetal growth restriction and at week 27 the fetus died (May 2018). On Oct 2018 (off-label) rituximab 375 mg/m2 (700 mg) once a week for four weeks was administered and the next pregnancy was planned after six months from the last administration. She had her forth pregnancy on Apr 2019 and started prophylaxis with enoxaparin 10,000 UI bid. We observed a progressive decrease of antiphospholipid antibody titer during pregnancy (figure), that ended with vaginal delivery at week 35 (Dec 2019) of a male newborn of 2,820 g, healthy despite mild immunodepression.
Conclusions: Rituximab could be a therapeutic approach in pregnant women with triple APS and previous obstetrical complications. This is the first case in which rituximab has been effectively used before a pregnancy in a patient with refractory obstetrical APS.
To cite this abstract in AMA style:Ciavarella A, Gianniello F, Artoni A, Capecchi M, Bucciarelli P, Peyvandi F, Martinelli I. Rituximab before Pregnancy in Refractory Obstetrical Antiphospholipid Syndrome [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/rituximab-before-pregnancy-in-refractory-obstetrical-antiphospholipid-syndrome/. Accessed October 20, 2021.
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