Anticoagulation in Management of Antiphospholipid Antibody Syndrome in Pregnancy

Abstract

Synopsis Our knowledge of antiphospholipid antibodies and their impact on pregnancy continues to evolve. A variety of antiphospholipid antibodies have been identified but not all of them seem to be pathologic for pregnancy outcome. Our understanding of which patients are at high risk for adverse pregnancy outcome and the most effective treatment will require clinical trials based on risk stratification and long term follow-up of infants.

Antithrombotic therapy to prevent recurrent pregnancy loss in antiphospholipid syndrome—What is the evidence?

“…It is known that the prognosis varies between subgroups of antiphospholipid syndrome patients. 7,19,41,[45][46][47] Reporting of antibody profiles or the number of previous pregnancy losses was incomplete and not in relation to the primary outcome live birth. For this reason, we were unable to perform subgroup comparisons based on number of previous miscarriages (two vs. three or more), previous placentamediated complications, high-titer antibodies versus low-titer antibodies, or positive LAC versus negative LAC.…”

“…Criteria for antiphospholipid syndrome and pregnancy loss are consensus based and further research regarding which subgroups benefit from antithrombotic therapy should be carried out. It is known that the prognosis varies between subgroups of antiphospholipid syndrome patients 7,19,41,45–47 . Reporting of antibody profiles or the number of previous pregnancy losses was incomplete and not in relation to the primary outcome live birth.…”

Immunological tolerance, pregnancy and pre-eclampsia: the roles of semen microbes and the father1

“…Specifically, our finding that very low concentrations of cell wall products can induce amyloid formation during blood clotting [446; 448] has been further extended to recognise the ubiquity of the phenomenon in chronic, inflammatory diseases [447; 448; 616; 714-716]. Often, an extreme example gives strong pointers, and the syndrome with the highest likelihood of developing PE is antiphospholipid syndrome [717][718][719][720][721], which is also caused by infection [722][723][724][725][726][727] where the coagulopathies are also especially noteworthy [728][729][730][731][732]. Consequently, the recognition of PE as a amyloidogenic coagulopathy [32; 733-735] is significant.…”

Clinical Considerations on Anticoagulation Management in Cardiovascular Diseases During Pregnancy

“…For women with a history of unprovoked thrombosis not on life-long anticoagulation, either low-dose anticoagulation or close observation with postpartum prophylaxis is recommended. Treatment begins at conception and continues for 6-12 weeks postpartum regardless of history of thrombosis [James et al, 2006b;Lockshin, 2013]. Elastic stockings are safe and should be used during thrombophylaxis in women with a highrisk profile and multiple risk factors for VTE [Bates et al, 2012].…”