Aspirin or heparin or both for improving pregnancy outcomes in women with persistent antiphospholipid antibodies and recurrent pregnancy loss

Hamulyák, Eva N.; Scheres, Luuk J. J.; Marijnen, Mauritia C.; Goddijn, Mariëtte; Middeldorp, Saskia

doi:10.1002/14651858.cd012852.pub2

Cited by 78 publications

(79 citation statements)

References 101 publications

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“…NSAIDs, [38][39][40][41][42][43][44][45] two antiepileptics, [46][47][48] two β-blockers, [49][50][51] two calcium channel blockers, 50,52 two antiemetics (5-HT3 receptor antagonists), 53,54 two antipsychotics, 55,56 two antihistamines, 57,58 and one each assessed serotonin and norepinephrine reuptake inhibitors (SNRIs), 59,60 tricyclic antidepressants, 59,60 benzodiazepines, 61,62 corticosteroids, 63 oral magnesium, 64 triptans (5-HT1B/1D receptor agonists), 65 analgesics/antipyretics, 66 and intravenous magnesium. 67 Twelve SRs reported maternal adverse effects and 23 reported fetal/child adverse effects.…”

Section: All 26 Srs Assessed Pharmacologic Interventions: Eight Assessedmentioning

confidence: 99%

Management of primary headaches during pregnancy, postpartum, and breastfeeding: A systematic review

et al. 2021

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Background: Primary headaches (migraine, tension headache, cluster headache, and other trigeminal autonomic cephalgias) are common in pregnancy and postpartum. It is unclear how to best and most safely manage them. Objective: We conducted a systematic review (SR) of interventions to prevent or treat primary headaches in women who are pregnant, attempting to become pregnant, postpartum, or breastfeeding. Methods: We searched Medline, Embase, Cochrane CENTRAL, CINAHL, ClinicalTrials. gov, Cochrane Database of SRs, and Epistemonikos for primary studies of pregnant women with primary headache and existing SRs of harms in pregnant women regardless of indication. No date or language restrictions were applied. We assessed strength of evidence (SoE) using standard methods. Results: We screened 8549 citations for studies and 2788 citations for SRs. Sixteen studies (mostly high risk of bias) comprising 14,185 patients (total) and 26 SRs met the criteria. For prevention, we found no evidence addressing effectiveness. Antiepileptics, venlafaxine, tricyclic antidepressants, benzodiazepines, β-blockers, prednisolone, and oral magnesium may be associated with fetal/child adverse effects, but calcium channel blockers and antihistamines may not be (1 single-group study and 11 SRs; lowto-moderate SoE). For treatment, combination metoclopramide and diphenhydramine may be more effective than codeine for migraine or tension headache (1 randomized controlled trial; low SoE). Triptans may not be associated with fetal/child adverse effects (8 nonrandomized comparative studies; low SoE). Acetaminophen, prednisolone, indomethacin, ondansetron, antipsychotics, and intravenous magnesium may be associated with fetal/child adverse effects, but low-dose aspirin may not be (indirect evidence; low-to-moderate SoE). We found insufficient evidence regarding non-pharmacologic treatments.

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Section: All 26 Srs Assessed Pharmacologic Interventions: Eight Assessedmentioning

confidence: 99%

Management of primary headaches during pregnancy, postpartum, and breastfeeding: A systematic review

et al. 2021

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“…There is no difference in the efficacy of prophylactic anticoagulation comparing UFH to LMWH in RPL patients with APAs 91 . As LMWH is more convenient and has fewer complications, there are a large number of studies with LMWH for those who need extended time usages.…”

Section: Anticoagulantsmentioning

confidence: 99%

Inherited thrombophilia and anticoagulant therapy for women with reproductive failure

Han

Lee

2020

American J Rep Immunol

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Reproductive failure (RF) is the inability to conceive or to carry a pregnancy to term, and its prevalence is not negligible. Pregnancy is a prothrombotic condition, which can be abnormally exaggerated in women with thrombophilia. Antiphospholipid syndrome is a cause of RF and effectively managed with heparin and aspirin. However, there are yet insufficient data in patients with RF and inherited thrombophilia. This review focuses on the significance of inherited thrombophilia and RF and the role of anticoagulants in pregnancy outcomes. A few randomized case‐control studies have investigated the effect of anticoagulation in RF with thrombophilia, and the results are yet debatable. Some inherited thrombophilia including mutations of factor V Leiden, prothrombin, and methylenetetrahydrofolate reductase and protein S deficiency are associated with RF and/or late pregnancy complications. There are several implications which influence the diagnosis and treatment. First, there is a lack of studies revealing appropriate thrombophilia markers and its cutoff values for RF specifically. Second, some thrombophilia markers change with sex and age. Lastly, the study designs of previous studies are heterogeneous in selecting the thrombophilia markers and drugs. Further studies to find adequate thrombophilia markers of RF are warranted and eventually elucidate the subgroups beneficial to anticoagulation treatment.

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“…However, other publications question this strategy, as well as the cessation of therapy in gestational week 34+0, and suggest an even longer therapy. A recent study could show that the incidence of pregnancy loss in women with NC APLS was significantly lower in the group treated with low-molecular-weight heparin (LMWH) and low dose aspirin (LDA) compared to LDA alone, whereas a Cochrane review from 2020 concluded that heparin in combination with LDA may increase LBR, but further research is needed [ 36 , 170 , 171 ]. The European League Against Rheumatism (EULAR) differentiates the administration of LDA and/or heparin between OAPLS, NC-OAPLS, and thrombotic APLS: (1) Thrombotic APLS is recommended to be treated with LDA and heparin in therapeutic dosage during pregnancy; (2) if recurrent pregnancy complications occur in patients with OAPLS, increasing heparin to therapeutic dosage or addition of low dose prednisolone or hydroxychloroquine in the first trimester could be considered; (3) during pregnancy, treatment with LDA alone or in combination with heparin depending on the individual risk profile is recommended in patients with NC-OAPLS [ 135 ].…”

Section: Therapeutic Optionsmentioning

confidence: 99%

Immunological Risk Factors in Recurrent Pregnancy Loss: Guidelines Versus Current State of the Art

Vomstein

Feil

Strobel

et al. 2021

JCM

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Around 1–5% of all couples experience recurrent pregnancy loss (RPL). Established risk factors include anatomical, genetic, endocrine, and hemostatic alterations. With around 50% of idiopathic cases, immunological risk factors are getting into the scientific focus, however international guidelines hardly take them into account. Within this review, the current state of immunological risk factors in RPL in international guidelines of the European Society of Reproduction and Embryology (ESHRE), American Society of Reproductive Medicine (ASRM), German/Austrian/Swiss Society of Obstetrics and Gynecology (DGGG/OEGGG/SGGG) and the Royal College of Obstetricians and Gynecologists (RCOG) are evaluated. Special attention was drawn to recommendations in the guidelines regarding diagnostic factors such as autoantibodies, natural killer cells, regulatory T cells, dendritic cells, plasma cells, and human leukocyte antigen system (HLA)-sharing as well as treatment options such as corticosteroids, intralipids, intravenous immunoglobulins, aspirin and heparin in RPL. Finally, the current state of the art focusing on both diagnostic and therapeutic options was summarized.

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Aspirin or heparin or both for improving pregnancy outcomes in women with persistent antiphospholipid antibodies and recurrent pregnancy loss

Cited by 78 publications

References 101 publications

Management of primary headaches during pregnancy, postpartum, and breastfeeding: A systematic review

Management of primary headaches during pregnancy, postpartum, and breastfeeding: A systematic review

Inherited thrombophilia and anticoagulant therapy for women with reproductive failure

Immunological Risk Factors in Recurrent Pregnancy Loss: Guidelines Versus Current State of the Art

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