16th International Congress on Antiphospholipid Antibodies Task Force Report on Obstetric Antiphospholipid Syndrome

Jesús, Guilherme Ramires de; Benson, Ashley E.; Chighizola, Cecilia Beatrice; Sciascia, Savino; Branch, D. Ware

doi:10.1177/0961203320954520

Cited by 28 publications

(22 citation statements)

References 111 publications

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“…Indeed, anti-D1 antibodies carry a prominent risk for vascular event, with an odds ratio of approximately 2 [19]. A multifaceted scenario emerges when evaluating anti-D1 antibodies and obstetric complications: anti-D1 reactivity predicts late complications, but not early abortion, potentially reflecting the placental resistance to ischemic damages in early gestation [26,27]. Some authors have proposed aCL and anti-β2GPI IgA as more reliable APS biomarkers compared to IgM [28].…”

Section: Laboratory Detection Of Antiphospholipid Antibodiesmentioning

confidence: 99%

Pediatric Antiphospholipid Syndrome: from Pathogenesis to Clinical Management

et al. 2021

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Purpose of Review Elucidating the pathogenic mechanisms mediated by antiphospholipid antibodies (aPL) might exert important clinical implications in pediatric antiphospholipid syndrome (APS). Recent Findings aPL are traditionally regarded as the main pathogenic players in APS, inducing thrombosis via the interaction with fluid-phase and cellular components of coagulation. Recent APS research has focused on the role of β2 glycoprotein I, which bridges innate immunity and coagulation. In pediatric populations, aPL should be screened in appropriate clinical settings, such as thrombosis, multiple-organ dysfunction, or concomitant systemic autoimmune diseases. Children positive for aPL tests often present non-thrombotic non-criteria manifestations or asymptomatic aPL positivity. In utero aPL exposure has been suggested to result in developmental disabilities, warranting long-term follow-up. Summary The knowledge of the multifaceted nature of pediatric APS should be implemented to reduce the risk of underdiagnosing/undertreating this condition. Hopefully, recent pathogenic insights will open new windows of opportunity in the management of pediatric APS.

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Section: Laboratory Detection Of Antiphospholipid Antibodiesmentioning

confidence: 99%

Pediatric Antiphospholipid Syndrome: from Pathogenesis to Clinical Management

et al. 2021

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“…There is great interest in drugs that could affect the pathophysiological mechanisms of the disease, such as hydroxychloroquine (HCQ) (5-6 mg/kg/day), statins, and certolizumab pegol (CTZ). Regarding HCQ, the most recent international task force report highlighted the efficacy of HCQ and the need for clinical trials of HCQ in patients with obstetric APS [89]. In an in vitro study, HCQ inhibited aPL binding to trophoblasts and restored their function [90].…”

Section: General Considerationsmentioning

confidence: 99%

Obstetric anti-phospholipid syndrome: from pathogenesis to treatment

Kaneko

Ozawa

Murashima

2021

Immunological Medicine

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Antiphospholipid syndrome (APS) is an autoimmune disease characterized by clinical manifestations such as thrombosis and obstetric complications with documented persistence of antiphospholipid antibodies (aPLs). Recent studies have revealed that the cause of aPLrelated obstetric complications is dysfunction of placental trophoblasts and inflammation of the maternal-fetal interface induced by aPLs, not thrombosis. Although aPLs are associated with recurrence of serious complications during pregnancy, appropriate combination therapy with heparin and low-dose aspirin can improve the course of 70-80% of subsequent pregnancies. Preconception counseling and patient-tailored treatment are fundamental to improving maternal and fetal outcomes. Non-anticoagulant treatments such as hydroxychloroquine and statins are being developed for cases refractory to conventional treatment. Risk factors for thrombosis after pregnancy complications were identified based on the analysis of large databases of obstetric APS.

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“…Although the combination LDA plus heparin certainly provides an element of maternal thromboprophylaxis and may improve pregnancy outcomes, women with clinical and/or biological risk factors are at increased risk of adverse pregnancy outcomes in spite of that standard treatment. These risk factors include a personal history of thrombosis, SLE, foetal death, or early delivery for severe preeclampsia or placental insufficiency, and repeated LA or triple positivity [ 7 ]. Moreover, in PROMISSE, a prospective observational study of 724 patients, 44% of pregnancies in women with APS and positive LA resulted in adverse pregnancy outcomes despite treatment with heparin and LDA [ 62 ].…”

Section: Managementmentioning

confidence: 99%

“…While the efficacy of this regimen with regard to maternal thromboprophylaxis is well established, low evidence still exists in terms of embryonic/foetal outcomes and second/third trimester complications [ 7 ]. In fact, refractory obstetric APS may occur in about 30% of cases, despite tight pregnancy monitoring and the use of treatment combination with LDA plus LMWH [ 57 ].…”

Section: Managementmentioning

confidence: 99%

“…Obstetric APS is the most frequent treatable autoimmune disease during pregnancy [ 6 ]. It refers to patients who meet laboratory criteria for APS and have experienced prior pregnancy complications, including miscarriage, unexplained foetal death, and premature birth, with recurrent early miscarriage being the most common clinical scenario [ 7 ]. In contrast to thrombotic APS, obstetric events related to aPL are mainly due to complement activation and proinflammatory effects of aPL on decidual cells and trophoblasts without a real thrombophilic state, which result in defective placentation [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Management of Antiphospholipid Syndrome

Ghembaza

Saadoun

2020

Biomedicines

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Antiphospholipid syndrome (APS), is an acquired autoimmune disorder characterised by thrombosis, pregnancy morbidity, and the presence of antiphospholipid antibodies (aPL). Although venous thromboembolism is the most common manifestation, thrombotic events in APS may also occur in virtually any vascular bed, with cerebral circulation being the arterial territory most commonly affected. As APS is a heterogeneous condition, its management should be tailored with a patient-centred approach based on individual risk assessment, which includes the aPL profile, concomitant auto-immune diseases, and traditional cardiovascular risk factors. Although literature data are conflicting regarding primary prophylaxis, there is some evidence indicating that antiplatelet agents may reduce the risk of a first thrombotic event in individuals with a high-risk profile. In patients with thrombotic APS, current evidence-based guidelines recommend lifelong vitamin K antagonists (VKAs), preferably warfarin. The optimal intensity of anticoagulation following arterial thrombosis remains controversial. Arterial thrombosis should be treated either with high-intensity warfarin at a target INR > 3.0, or low-dose aspirin (LDA) combined with moderate-intensity warfarin (INR 2.0–3.0). It is recommended to avoid direct oral anticoagulants (DOACs) in patients with high-risk APS, mainly those with triple-positive PL and previous arterial events. They would only be used exceptionally in selected patients with low-risk venous thromboembolism (VTE). In low-risk VTE patients currently treated with a DOAC due to warfarin intolerance or a previous unstable International Normalized Ratio on warfarin, the decision of continuing DOACs would be taken in carefully selected patients. In women with obstetric APS, the combination therapy with LDA plus heparin remains the conventional strategy.

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16th International Congress on Antiphospholipid Antibodies Task Force Report on Obstetric Antiphospholipid Syndrome

Cited by 28 publications

References 111 publications

Pediatric Antiphospholipid Syndrome: from Pathogenesis to Clinical Management

Pediatric Antiphospholipid Syndrome: from Pathogenesis to Clinical Management

Obstetric anti-phospholipid syndrome: from pathogenesis to treatment

Management of Antiphospholipid Syndrome

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