Apheresis and intravenous immunoglobulins used in addition to conventional therapy to treat high-risk pregnant antiphospholipid antibody syndrome patients. A prospective study

Ruffatti, Amelia; Favarò, Maria; Hoxha, Ariela; Zambon, A.; Marson, Piero; Ross, Teresa Del; Calligaro, Antonia; Tonello, Marta; Nardelli, Giovanni Battista

doi:10.1016/j.jri.2016.03.004

Cited by 44 publications

(33 citation statements)

References 29 publications

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“…Ruffatti et al [37] 2016 Case series Plasma exchange plus IVIG, therapeutic heparin and low-dose aspirin Live birth rate 17/18 (94.4 %)…”

Section: Authors (Reference) Year Clinical Reports Treatment Protocolmentioning

confidence: 99%

“…The safety of both plasma exchange or immunoadsorption procedures during pregnancy is well documented [30][31][32][33][34][35][36][37]. In order to avoid bleeding during plasmapheresis treatment, as plasmapheresis temporarily removes blood clotting factors, in heparin-treated patients, it is important that the morning heparin, performed after the session, was halved [37].…”

Section: Additional Treatments In High-risk Obstetric Apsmentioning

confidence: 99%

“…In order to avoid bleeding during plasmapheresis treatment, as plasmapheresis temporarily removes blood clotting factors, in heparin-treated patients, it is important that the morning heparin, performed after the session, was halved [37]. Both extracorporeal blood purification techniques are known to lower [87,88].…”

Section: Additional Treatments In High-risk Obstetric Apsmentioning

confidence: 99%

“…Both extracorporeal blood purification techniques are known to lower [87,88]. Their use in pregnant APS patients has, nevertheless, been circumscribed, and descriptions in the literature are limited to case reports [28,30,31,35,36] and case series [32][33][34]37]. Both aphaeresis procedures have, in any case, always been administered in addition to other treatments, including steroids, heparin/LDA or IVIG, and have been associated to a live birth rate ranging between 71.4 and 100 % of the treated cases [33,34,37].…”

Section: Additional Treatments In High-risk Obstetric Apsmentioning

confidence: 99%

“…The protocols outlined above fail in about 20 % of pregnant APS women [17], and additional treatments including intravenous immunoglobulins (IVIG) [18][19][20][21][22][23][24][25][26][27][28] (Table 1), low-dose prednisolone [29], or aphaeresis procedures such as plasma exchange or immunoadsorption [30][31][32][33][34][35][36][37] have, at times, been combined with conventional therapies (Table 2). Due to the low number of treated cases, the efficacy of these protocols is at present not well established.…”

Section: Introductionmentioning

confidence: 99%

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Additional Treatments for High-Risk Obstetric Antiphospholipid Syndrome: a Comprehensive Review

Ruffatti

Hoxha

Favarò

et al. 2016

Clinic Rev Allerg Immunol

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Most investigators currently advocate prophylactic-dose heparin plus low-dose aspirin as the preferred treatment of otherwise healthy women with obstetric antiphospholipid syndrome, whilst women with a history of vascular thrombosis alone or associated with pregnancy morbidity are usually treated with therapeutic heparin doses in association with low-dose aspirin in an attempt to prevent both thrombosis and pregnancy morbidity. However, the protocols outlined above fail in about 20 % of pregnant women with antiphospholipid syndrome. Identifying risk factors associated with pregnancy failure when conventional therapies are utilized is an important step in establishing guidelines to manage these high-risk patients. Some clinical and laboratory risk factors have been found to be related to maternal-foetal complications in pregnant women on conventional therapy. However, the most efficacious treatments to administer to high-risk antiphospholipid syndrome women in addition to conventional therapy in order to avoid pregnancy complications are as yet unestablished. This is a comprehensive review on this topic and an invitation to participate in a multicentre study in order to identify the best additional treatments to be used in this subset of antiphospholipid syndrome patients.

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“…Ruffatti et al [37] 2016 Case series Plasma exchange plus IVIG, therapeutic heparin and low-dose aspirin Live birth rate 17/18 (94.4 %)…”

Section: Authors (Reference) Year Clinical Reports Treatment Protocolmentioning

confidence: 99%