Aspirin desensitization in the treatment of antiphospholipid syndrome during pregnancy in ASA-sensitive patients.

PROBLEM: Antiphospholipid syndrome (APS) is associated with thrombosis and poor pregnancy outcome in the presence of antiphospholipid antibodies (aPL). Patients with aPL have a high risk of foetal loss. However, with low-dose aspirin (acetylsalicylic acid; ASA) in combination with subcutaneous heparin, the chances of full-term delivery increase. Nevertheless, ASA treatment is avoided in pregnant, ASA-sensitive women with APS.

METHODS

Rapid oral challenge-desensitization to ASA was performed in four pregnant women with a history of APS and aspirin sensitivity. In three patients, desensitization was performed during pregnancy and before the next pregnancy in the fourth. Desensitization was carried out in the ICU using increasing doses of aspirin (0.1-125 mg) over a 24-hr period.

RESULTS

Successful ASA desensitization was achieved in all the patients. No severe side effects occurred during the desensitization test. Only one patient required a small oral dose of antihistamines.

CONCLUSIONS

Aspirin desensitization may be a safe alternative even during pregnancy if carefully monitored and permit patients with APS to receive treatment with ASA. This would constitute a new indication in pregnant women with APS and ASA sensitivity.