Ruffatti A, Tonello M, Favaro M, et al. - In view of the uncertainty concerning the most efficacious strategy to manage pregnant patients with antiphospholipid syndrome (APS) refractory to conventional heparin/low-dose aspirin treatment or at high risk of adverse pregnancy outcomes, researchers here examined the efficacy and safety of the second-line therapies most commonly employed in addition to conventional therapy, and analyzed the data to identify those associated with the best pregnancy outcomes. Searching Medline via Pubmed, the Web of Science platform, the Cochrane library database and clinicaltrials.gov, they retrieved 14 studies meeting the eligibility criteria of the review: six retrospective cohort studies, one case-control, one case-series and six case reports. Findings support the use of low-dose intravenous immunoglobulins (IVIG) (< 2 g/Kg/month) or hydroxychloroquine 400 mg/day initiated prior to pregnancy in women with APS refractory to conventional therapy, while the use of high-dose IVIG (2 g/Kg/month) associated with plasma exchange or alone in those with high risk±refractory APS.