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Recurrent thrombosis prevention with intravenous immunoglobulin and hydroxychloroquine during pregnancy in a patient with history of catastrophic antiphospholipid syndrome and pregnancy loss

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Abstract

We report a case of a 36-year old patient with prior history of thrombosis in a setting of antiphospholipid antibody syndrome (APS) as well as pregnancy-associated catastrophic antiphospholipid syndrome (CAPS), resulting in multi-organ infarction and pregnancy loss. The episode of CAPS occurred while she was receiving antepartum low-dose aspirin and therapeutic-dose enoxaparin. This patient presented again at 6 weeks gestation and ultrasounds were consistent with fetal growth restriction, concerning for placental insufficiency and thrombosis. This time, hydroxychloroquine and monthly intravenous immunoglobulin (IVIG) infusions were added to her prophylaxis regimen, resulting in a successful delivery. Platelet count and antiphospholipid antibody titers were routinely monitored throughout pregnancy as markers of disease activity for APS. Current thromboprophylaxis guidelines do not address therapeutic options to prevent further pregnancy morbidity in women who develop recurrent episodes of thrombosis or CAPS despite receiving adequate anti-thrombotic treatment. Use of hydroxychloroquine and IVIG has been associated with good outcomes in this subset of patients.

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Authors and Affiliations

  1. Department of Hematology/Oncology, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT, 06030, USA

    Nataliya Mar & Karen Hook

  2. University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06030, USA

    Rebecca Kosowicz

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  1. Nataliya Mar
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  2. Rebecca Kosowicz
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  3. Karen Hook
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Correspondence to Nataliya Mar.

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Mar, N., Kosowicz, R. & Hook, K. Recurrent thrombosis prevention with intravenous immunoglobulin and hydroxychloroquine during pregnancy in a patient with history of catastrophic antiphospholipid syndrome and pregnancy loss. J Thromb Thrombolysis 38, 196–200 (2014). https://doi.org/10.1007/s11239-014-1061-x

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  • DOI: https://doi.org/10.1007/s11239-014-1061-x

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