OJOG  Vol.2 No.4 , November 2012
A case of a patient positive for anti-cardiolipin antibodies with recurrent fetal wastage and cerebral infarction who was successfully treated with Sairei-to, low dose aspirin, and heparin
ABSTRACT
We report a successful case of a pregnant female positive for anti-cardiolipin antibodies who experienced two abnormal pregnancies with postpartum cerebral hemispheric infarctions. A 38-year-old female diagnosed as being positive for anti-cardiolipin antibodies was referred to our hospital due to her strong desire to have a baby. The administration of Japanese herbal medicine, Sairei-to, as immunosuppressive therapy, and low dose aspirin, as anti-coagulation therapy, were initiated prior to the patient’s pregnancy. Five months after beginning the treatment, the patient conceived spontaneously. At 34 weeks of gestation, emergency cesarean section was performed due to increasing genital bleeding resulting from coincidental placenta previa and the patient delivered an appropriate-for-date female infant (1970 g). Treatment with Japanese herbal medicine (Sairei-to) and low-dose aspirin is considered to be an effective treatment option for patients positive for anti-phospholipid antibodies with past histories of abnormal pregnancies.

Cite this paper
Nonaka, T. , Chihara, M. , Ooki, I. , Tamura, M. , Kurabayashi, T. and Takakuwa, K. (2012) A case of a patient positive for anti-cardiolipin antibodies with recurrent fetal wastage and cerebral infarction who was successfully treated with Sairei-to, low dose aspirin, and heparin. Open Journal of Obstetrics and Gynecology, 2, 398-401. doi: 10.4236/ojog.2012.24082.
References
[1]   Hughes, G.R., Harris, E.N. and Gharavi, A.E. (1986) The anticardiolipin syndrome. Journal Rheumatology, 13, 486-491.

[2]   Triplett, D.A. (1989) Antiphospholipid antibodies and recurrent pregnancy loss. American Journal of Reproductive Immunology, 20, 52-67.

[3]   Gleicher, N. (1997) Antiphospholipid antibodies and reproductive failure: What they do and what they do not do; how to, and how not to treat? Human Reproduction, 12, 13-16. doi:10.1093/humrep/12.1.13

[4]   Yasuda, M., Takakuwa, K., Tokunaga, A. and Tanaka, K. (1995) Prospective studies of the association between anticardiolipin antibody and outcome of pregnancy. Obstetrics and Gynecology, 86, 555-559. doi:10.1016/0029-7844(95)00247-O

[5]   Lockwood, C.J., Romero, R., Feinberg, R.F., Clyne, L.P., Coster, B. and Hobbins, J.C. (1989) The prevalence and biologic significance of lupus anticoagulant and anticardiolipin antibodies in a general obstetric population. American Journal of Obstetrics and Gynecology, 161, 369-373.

[6]   Lynch, A., Marlar, R., Murphy, J., Davila, G., Santos, M., Rutledge, J. and Emlen, W. (1994) Antiphospholipid antibodies in predicting adverse pregnancy outcome. A prospective study. Annals of Internal Medicine, 120, 470- 475.

[7]   Takakuwa, K., Yasuda, M., Hataya, I., Sekizuka, N., Tamura, M., Arakawa, M., Higashino, M., Hasegawa, I. and Tanaka, K. (1996) Treatment for patients with recurrent abortion with positive antiphospholipid antibodies using a traditional Chinese herbal medicine. Journal of Perinatal Medicine, 24, 489-494. doi:10.1515/jpme.1996.24.5.489

[8]   Takakuwa, K., Ishii, K., Takaki, Y., Natsume, N., Adachi, H., Kurata, H., Tamura, M., Kurabayashi, T. and Tanaka, K. (2003) Effect of Sairei-to combined with aspirin and prednisolone on four recurrent reproductive failure women who are positive for anti-phospholipid antibodies. American Journal of Chinese Medicine, 31, 659-663. doi:10.1142/S0192415X03001326

[9]   Takakuwa, K., Ooki, I., Nonaka, T., Tamura, N., Ishii, K., Kikuchi, A., Tamura, M. and Tanaka, K. (2006) Prophylactic therapy for patients with reproductive failure who were positive for anti-phospholipid antibodies. American Journal of Reproductive Immunology, 56, 237-242. doi:10.1111/j.1600-0897.2006.00421.x

[10]   Hasegawa, I., Takakuwa, K., Goto, S., Yamada, K., Seki-uka, N., Kanazawa, K. and Tanaka, K. (1992) Effectiveness of prednisolone/aspirin therapy for recurrent aborters with antiphospholipid antibody. Human Reproduction, 7, 203-207.

[11]   Kutteh, W.H. (1996) Antiphospholipid antibody-associated recurrent pregnancy loss: Treatment with heparin and low-dose aspirin is superior to low-dose aspirin alone. Obstetrics and Gynecology, 174, 1584-1589. doi:10.1016/S0002-9378(96)70610-5

[12]   Rai, R., Cohen, H., Dave, M. and Regan, L. (1997) Randomized controlled trial of aspirin and aspirin plus heaprin in pregnant women with recurrent miscarriage associated with phospholipid antibodies (or antiphospholipid antibodies). British Medical Journal, 314, 253-257. doi:10.1136/bmj.314.7076.253

[13]   Branch, D.W., Silver, R.M., Blackwell, J.L., Reading, J.C. and Scott, J.R. (1992) Outcome of treated pregnancies in women with antiphospholipid syndrome: An update of the Utah experience. Obstetrics and Gynecology, 80, 614-620.

[14]   Lassere, M. and Empson, M. (2004) Treatment of anti-phospholipid syndrome in pregnancy: A systematic review of randomized therapeutic trials. Thrombosis Research, 114, 419-426. doi:10.1016/j.thromres.2004.08.006

[15]   Hasegawa, I., Takakuwa, K., Adachi, S. and Kanazawa, K. (1990) Cytotoxic antibody against trophoblast and lymphocytes present in pregnancy with intrauterine fetal growth retardation and its relation to anti-phospholipid antibody. Journal of Reproductive Immunology, 17, 127-139. doi:10.1016/0165-0378(90)90031-Z

[16]   Katsuragawa, H., Kanzaki, H., Inoue, T., Hirano, T., Mori, T. and Rote, N.S. (1997) Monoclonal antibody against phosphatidylserine inhibits in vitro human trophoblastic hormone production and invasion. Biology of Reproduction, 56, 50-58. doi:10.1095/biolreprod56.1.50

[17]   Rote, N.S., Vogt, E., De Vere, G., Obringer, A.R. and Ng, A. (1998) The role of placental trophoblast in the pathophysiology of the antiphospholipid antibody syndrome. American Journal of Reproductive Immunology, 39, 125-136. doi:10.1111/j.1600-0897.1998.tb00344.x

[18]   Ichikawa, G., Yamamoto, T., Chishima, F., Nakamura, A., Kuno, S., Murase, T. and Suzuki, M. (2011) Effect of anti-β2-glycoprotein I antibody on PIGF, VEGF and sVEGFR1 production from cultured choriocarcinoma cell line. Journal of Obstetrics and Gynaecology Research, 37, 1076-1083. doi:10.1111/j.1447-0756.2010.01490.x

[19]   Arakawa, M., Takakuwa, K., Honda, K., Tamura, M., Kurabayashi, T. and Tanaka, K. (1999) Suppressive effect of anticardiolipin antibody on the proliferation of human umbilical vein endothelial cells. Fertility and Sterility, 71, 1103-1107. doi:10.1016/S0015-0282(99)00117-X

[20]   Kimura, K., Nanba, S., Tojo, A., Matsuoka, H. and Sugimoto, T. (1990) Effect of Sairei-to on the relapse of steroid-dependent nephrotic syndrome. American Journal of Chinese Medicine, 18, 45-50. doi:10.1142/S0192415X90000071

[21]   Liu, X.Y. (1995) Therapeutic effect of chan-ling-tang (Sairei-to) on the steroid-dependent nephrotic syndrome in children. American Journal of Chinese Medicine, 23, 255-260. doi:10.1142/S0192415X95000304

[22]   Nakano, Y., Suda, T., Tozawa, F., Dobashi, I., Sato, Y., Ohmori, N., Sumitomo, T. and Demura, H. (1993) Saireito (a Chinese herbal drug)-stimulated secretion and synthesis of pituitary ACTH are mediated by hypothalamic corticotropin-releasing factor. Neuroscience Letters, 160, 93-95. doi:10.1016/0304-3940(93)90921-7

[23]   Tozawa, F., Dobashi, I., Horiba, N., Sakai, Y., Sakai, K. and Suda, T. (1998) Saireito (a Chinese herbal drug) decreases inhibitory effect of prednisolone and accelerates the recovery of rat hypothalamic-pituitary-adrenal axis. Endocrine Journal, 45, 69-74. doi:10.1507/endocrj.45.69

 
 
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