Welcome back to my Autoimmune Fertility series. This blog discusses common treatments for women with positive antiphospholipid antibodies (aPL). In the blog prior to this one, you will see information about how aPL associates with both blood clotting, pregnancy complications and Antiphospholipid syndrome.
My name is Karen Reynolds and I have specialized in acupuncture for women’s health and infertility for 18 years and have been a critical care RN for 29 years. I have fertility patients on various medications to address low levels of antiphospholipid antibodies (aPL) as well as women with a bona fide diagnosis of Antiphospholipid syndrome. Medications are thoughtfully selected by your medical doctor based upon your health history including laboratory testing, your reproductive history and your pregnancy history.
In this article, I want to share information on typically used aPL medications as well as acupuncture. Both are treatments for women with positive anti-phospholipid antibodies (aPL). Both are also key with improved pregnancy outcomes.
What types of medications treat women with positive antiphospholipid antibodies or with Antiphospholipid syndrome?
Below you will find commonly prescribed medications for aPL or Antiphospholipid syndrome. Broadly speaking, most agents address prevention of blood clots or reduction in inflammation. Please note there are multiple medical approaches with respect to treating aPL. There is also agreement among experts that more research is needed in this area.
A word about anticoagulant medications
Because aPL are intimately connected to blood clot risks or “thrombotic events”, anticoagulant medications are most frequently prescribed by doctors. Historically it was believed that aPL contributed to blood clotting in the placenta which then resulted in pregnancy loss.1 However, over time and examination of placentas, doctors were not finding evidence of this. It is now believed that anticoagulant medications like Heparin or Lovenox help by indirectly reducing inflammation. Specific types of inflammation in your immune system can target and attack fetal cells.2
What specific medicines are used to treat aPL?
There are varieties of medications that are used and these are selected by your doctor. Please note that these may not be the same for each woman owing to different health, reproductive and pregnancy histories.
Pharmaceuticals used to treat aPL
- Low Dose Aspirin (LDASA)
- Anticoagulants such as Unfractionated Heparin (UFH) or Low Molecular Weight Heparin (LMWH) (see below for more information on Heparin)
- Prednisone or Betamethasone
- Hydroxychloroquine (Plaquenil)
- Intravenous Immune Globulin (IVIG)
- Pravastatin (can be used in instances of preterm pre-eclampsia)3
Why are there different types of Heparin used to treat aPL or Antiphospholipid syndrome?
Unfractionated Heparin (UFH)
This type of Heparin is the oldest in use but is considered limited with respect to aPL treatment. UFH binds more generally to body proteins beyond those in the blood clotting cascade. Dose-response is quite variable person to person too. This means frequent blood draws are needed to monitor bleeding times and a there is a higher risk for bleeding side effects. I have seen intravenous drips of this style heparin emergently used in intensive care units when patients have developed large clots.
Low Molecular Weight Heparin (LMWH)
LMWH products have precise molecular weights which determine specifically where in the blood clotting cascade they work. LMWH are specific also in length of time in which they are active in the body. This means the dose-response is more reliable; so, there are fewer risks for bleeding. Lovenox is the type of LMWH which I most frequently see prescribed by doctors to my patients.
So why is an acupuncturist so interested in writing about autoimmune related fertility topics? How can I help and why listen to me?
Firstly: at heart, I am a science nerd. At any given time, my home office has at least 2 banker’s boxes stuffed full of research studies which span many topics. I have a passion for studying research, pulling the demonstrated medical facts as we know them at this time, and helping my patients apply that information to make them healthier and happier. My nursing background gives me a solid foundation for understanding what I am studying.
Secondly: there is substantial research showing that acupuncture has the ability to drop levels of inflammation in the body4,5,6,7. This is key for patients with autoimmune diagnoses such as aPL, Lupus, ANA, MTHFR, thyroid and connective tissue issues to name just a few. Reducing inflammatory factors floating around your system is key to a healthy pregnancy. Acupuncture together with conventional medicine optimizes your fertility!
Additional information on Antiphospholipid syndrome can be found here:
Thank you for reading!
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~Karen Reynolds, RN, MS, LAc
1Pantham, P., Abrahams, V. M., Chamley, L. W. (2106). The role of anti-phospholipid antibodies in autoimmune reproductive failure. Reproduction, 151, R79-R90.
2De Jesus, G. R., Agmon-Levin, N., Andrade, C. A., Andreoli, L., Chighizola, C. B., Porter, T. F., Salmon, J., Silver, R. M., Tincani, A., & Branch, D. W. (2014). 14th International Congres on Antiphospholipid Antibodies Task Force Report on Obstetric Antiphospholipid Syndrome. Autoimmunity Reviews, 13, 795-813. Retrieved from http://dx.doi.org/10.1016/j.autrev.2014.02.0031568-9972/
3Pantham, P., Abrahams, V. M., Chamley, L. W. (2106). The role of anti-phospholipid antibodies in autoimmune reproductive failure. Reproduction, 151, R79-R90.
4 McDonald, J.L., Cripps, A.W., Smith, P.K. (2015). Mediators, Receptors, and Signaling Pathways in the Anti-Inflammatory and Antihyperalgesic Effects of Acupuncture. Evidence-Based Complementary and Alternative Medicine, Volume 2015, Article ID 975632, 10 pages.
5Xiao, Q.S., Ma, M.Y., Zhang, X.S., Deng, M.H., Yang Yan, Z. (2015). Effect of Acupuncture on Prognosis and Immune Function of Sepsis Patients. Zhongguo Zhong Xi Yi Jie He Za Zhi, Jul; 35(7): 783-786.
6Kim, S K, Bae, H. (2010). Acupuncture and immune modulation. Autonomic Neuroscience: Basic and Clinical, 2010-10-28, Volume 157, Issue 1, Pages 38-41.
7 Ding, S.S., Hong, S.H., Wang, C., Guo, Y., Wang, Z.K., Xu, Y. (2013). Acupuncture modulates the neuru-endocrine-immune network. Quarterly Journal of Medicine, 107, 341-345. doi: 10.1093/qjmed/hct196
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