It revolves around a discovery we made quite a while ago, 25 years ago I think it was, that some people have slightly sticky blood, to put it in simple terms, and they have a tendency for the blood to clot, therefore there’s a danger of clots and things like that. But the two organs of the body that really are sensitive to lack of oxygen are the brain, so a lot of these patients get headaches, memory, balance, things like that, and the placenta in pregnancy. We think the predominant problem is the blood sludges in the placenta and the baby, or the foetus, doesn’t get enough oxygen and miscarries. We now know from simple blood tests we can identify most of these women and the tragedy for these women has been that they have many miscarriages, over twenty in a couple of my patients miscarriages. Even worse, they have late pregnancy losses, the baby dying at eight months and so on. We now know that this syndrome, which is called Hughes Syndrome, is the commonest treatable cause of recurrent miscarriage. In the old days recurrent miscarriage was just thought to be one of those things in many cases but we can now identify the women at risk. The treatment is some form of treatment to make blood flow better and of course the first choice is always aspirin, baby aspirin, 75mg or 80mg a day. That, about 15-20 years ago when we started doing this, we found that the success rate went up from about 15% to nearly 90% in women with the sticky blood.
It’s now becoming worldwide recognised and we’re campaigning, in a way, for more women to be tested. The current opinion is that you need only test after two or maybe three miscarriages and that’s for economic reasons because there are other causes of miscarriage. But I disagree, I think if a woman has had one miscarriage, certainly two, you should test because you can prevent a later late pregnancy loss and so on. What I’m going to talk about today is the clues to which women should be tested. There are many clues, like I mentioned migraine is one, balance, some of these patients are wrongly labelled as multiple sclerosis because they get pins and needles and balance problems. And any organ might be affected so you can get angina from sticky blood not giving the heart enough oxygen or memory loss and that’s a big one. A lot of our patients think they’re getting Alzheimer’s but it’s not, it’s simply the blood flow to the brain, the brain is stupid if it doesn’t get enough oxygen, you know, you get all those symptoms.
Is aspirin in the standard of care?
Yes, it is. There has been dispute about whether heparin, which is a more substantial anticoagulant, is better. The recent collection of data, the meta-analysis, suggests that for these women, perhaps the worst ones, anyway, the combination of heparin and aspirin is marginally superior to aspirin alone.
Does aspirin have other benefits for the patients?
Absolutely. It’s certainly noticeable when some of these patients with the classic symptoms of memory, balance, headaches, they improve within days of starting aspirin. And if they don’t we then go on to investigate more and often start heparin. And in severe cases, where you think you’re getting transient ischemic attack or worried about stroke, we go on to warfarin and that’s the definitive treatment.
Is aspirin given only during the pregnancy?
Yes, through the eight or nine months of pregnancy. That is, it’s disputed because if they have other features they might be wise. One of the things I was going to talk about is, great, you have a successful pregnancy at the age of 29, what happens ten years later? And that’s what we’re looking at. The argument, maybe, is for long-term aspirin for those people.
Could you talk about the charity that has formed around the Hughes Syndrome?
There’s a charity now in the UK, there’s also one developing in the US, but this has been going some time. It’s the Hughes Syndrome Foundation. That provides booklets, information and, for what it’s worth, I do a monthly blog on that, it’s called Patient of the Month telling you about patients that we’ve seen, the good and the bad side of it. There are specific booklets on pregnancy problems, on the other problems I’ve mentioned and it’s very popular. We have patients’ meetings twice a year as well, mainly at St Thomas’ Hospital.
