الفهرس 
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Abstract
The management of women with APAS is controversial. Treatment options included oral steroids, low-dose aspirin and heparin. Combined administration of low-dose aspirin and heparin (in thromboprophylactic doses) had the best outcome (Shehata et al., 2001).
Options concerning anticoagulant therapy include unfractionated heparin (UFH), low molecular weight heparin (LMWH) and oral warfarin. The major concern about the safety of these anticoagulant drugs is the risk of bleeding and teratogenicity. Neither UFH nor LMWH crosses the placenta, thus both having almost no risk of teratogenicity. On the contrary, oral warfarin does cross the placenta and thus having the potential risk of teratogenicity (Chan et al., 2000).
Yet, UFH (and to a lesser extent, LMWH) is associated with considerable patient’s discomfort related to frequent injections and is complicated by serious adverse effects with long-term therapy such as osteoporosis and heparin-induced thrombocytopenia (Ginsberg et al., 2003).
Aim of the study is to compare the safety of the use of oral warfarin during pregnancy with the use of heparin (whether unfractionated or low-molecular-weight) as regard perinatal outcome in women with recurrent pregnancy loss.
The current retrospective analysis study included a total of 503 pregnancies (in 305 women) who had their prenatal follow-up and delivered at Ain Shams University Maternity Hospital during the last 5 years. All included women received anticoagulant therapy (382 pregnancies)on subcutaneous unfractionated heparin and (121 pregnancies)on oral warfarin for a diagnosis of antiphospholipid antibody syndrome (APAS) or empirically to improve pregnancy outcome in women with unexplained recurrent pregnancy loss.
There were no significant differences between both groups regarding the outcome of pregnancy. Although warfarin was associated with a significantly higher risk of Cesarean deliveries, still the median hospital stay was significantly shorter in pregnancies of group I (Warfarin Group).
We recommend the use of Warfarin safely in pregnant patients with APS. Further research is required to ascertain the safest dose and time of starting and ceasing warfarin administration. The benefit of warfarin use outweighs risk.