Objective. To evaluate the relationship between the antiphospholipid profile and clinical characteristics of pregnant women with antiphospholipid syndrome (APS) and neonatal outcome. Methods. We retrospectively considered 109 treated pregnancies of 93 patients with primary APS and reviewed the medical records of their 111 infants. Neonatal outcome was assessed using the following variables: weeks of gestational age at delivery, percentiles of birth weight, Apgar score at 5 minutes, need for cardiopulmonary resuscitation in the delivery room, time in the neonatal intensive care unit, infections, and other neonatal complications. Univariate statistical analysis was performed to evaluate the relationship between APS maternal features and neonatal outcome parameters. Results. When maternal APS features and variables of infant outcome were analyzed, it was evident that lupus anticoagulant (LAC), triple antiphospholipid positivity, and history of vascular thrombosis were significantly associated with some parameters of a poor infant outcome. History of pregnancy morbidity alone was, instead, significantly correlated to the variables of favorable neonatal outcome. Conclusion. There seems to be more than one kind of pregnant woman with APS. Even when treated with a second-line therapy plan, mothers with LAC and/or triple antiphospholipid positivity and/or previous thromboembolism seem to have a high probability of poor neonatal outcome, whereas those with pregnancy morbidity alone, treated with conventional drugs, seem to have a high probability of favorable outcome.

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The current study evaluates the efficacy and safety of different treatment strategies for pregnant patients with antiphospholipid syndrome. One hundred twenty-seven consecutive pregnancies were assessed; 87 (68.5%) with a history of pregnancy morbidity alone were treated with prophylactic low molecular weight heparin (LMWH) + low-dose aspirin (LDA, 100 mg) (group I) and 40 (31.5%) with a history of thrombosis and/or severe pregnancy complications with therapeutic LMWH + LDA (group II). LMWH doses were increased throughout the pregnancies depending on the patients' weight gain, and treatment was switched to a more intensive one at the first sign of maternal/fetal complications. The study's primary outcome was live births. There were no significant differences in live birth rate between group I (95.4%) and group II (87.5%). Even fetal complication rate was similar in the two groups; group II nevertheless had a higher prevalence of maternal and neonatal complications (p = 0.0005 and p = 0.01, respectively) and registered a significantly lower gestational age at delivery and birth weight (p = 0.0001 and p = 0.0005, respectively). Two patients in group I switched to group II therapy, six patients in group II switched to a more intensive treatment strategy (weekly plasma exchange + fortnightly intravenous immunoglobulins in addition to therapeutic LMWH + LDA). The multivariate analysis uncovered that triple antiphospholipid antibodies positivity was an independent factor leading to a more intensive therapy. All eight switched patients achieved a live birth. Study results revealed that adjusted LMWH doses and switching therapy at first signs of severe pregnancy complications led to a high rate of live births in antiphospholipid syndrome patients.

Blood levels of fibrinogen degradation products (FDP), factor VIII (antigen and coagulant), plasminogen and antithrombin III, as well as fibrinogen half-life were studied in 15 patients on CAPD from 3–24 months; the daily loss of these factors in the dialysate was also determined. Fibrinogen and factor VIII levels were above (p < 0.05), fibrinogen half-life was below (p < 0.05) and AT III was within the normal range. The average daily protein loss in the dialysate was 7.74: t 2.42 g; fibrinogen loss was 48.14:t 41.66 mg;FDP241.37 :t 185.19 mg; plasminogen 11.16 :t 6.94, and AT IIl64.96 :t 37.67 mg. These findings suggest that patients on CAPD have a state of hypercoagulability similar to that observed in patients with the nephrotic syndrome. Continuous ambulatory peritoneal dialysis (CAPD) is accompanied by protein losses, which may lead to protein depletion (1). The situation is similar in the nephrotic syndrome (NS), which, in addition, has the features of a hypercoagulability state (2, 3). After observing the appearance of thrombotic events in some CAPD patients, we set out to determine whether patients undergoing continuous ambulatory peritoneal dialysis also have a hypercoagulability state and this paper presents our findings.

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