Comparative study between obstetric antiphospholipid syndrome and obstetric morbidity related with antiphospholipid antibodies

Alijotas‐Reig, Jaume; Esteve-Valverde, Enrique; Ferrer‐Oliveras, Raquel; Llurba, Elisa; Ruffatti, Amelia; Tincani, Anǵela; Lefkou, Elmina; Bertero, Ma Tiziana; Espinosa, Gerard; Carolis, Sara De; Rovere‐Querini, Patrizia; Lundelin, Krista; Picardo, Elisa; Mékinian, A.

doi:10.1016/j.medcli.2017.11.017

Cited by 25 publications

(20 citation statements)

References 25 publications

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“…8 In the EUROAPS cohort, 75.82% of the non-criteria APS patients received therapies and when treated both APS and non-criteria APS patients had similar good fetal-maternal outcomes. 18 Generally speaking, the treatment assigned to NCAPS patients was globally less intensive than APS patients. In our study, we could also tell that LMWH was used more in APS group than in NCAPS group.…”

Section: Discussionmentioning

confidence: 99%

Anticardiolipin Positivity Is Highly Associated With Intrauterine Growth Restriction in Women With Antiphospholipid Syndrome

Cai

et al. 2020

Clin Appl Thromb Hemost

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The purpose of our study was to evaluate pregnancy outcomes of women with antiphospholipid antibodies (aPL) positivity and assess risk factors associated with adverse pregnancy outcomes. Pregnant women with aPL positivity were enrolled prospectively in China from January 2017 to March 2020. Treatment of low-dose aspirin and low molecular weight heparin were given. Pregnancy outcomes and coagulation function were recorded and compared with normal pregnancies. Multivariable logistic regression was performed to identify risk factors associated to intrauterine growth restriction (IUGR). 270 pregnant women, including 44 diagnosed as Antiphospholipid syndrome (APS), 91 as non-criteria APS (NCAPS) and 135 normal cases as control, were enrolled in the study. The live birth rate in aPL carriers and APS group was 97% and 95.5%, respectively. Adverse pregnancy outcomes did not show significant difference between aPL carriers and normal pregnancies, and between APS and NCAPS, except for IUGR. The incidence of IUGR was significantly higher in aPL carriers than normal pregnancies, and in APS patients than NCAPS (P < 0.05). After controlling for age, in vitro fertilization (IVF), pregnancy losses related to APS and treatment, anticardiolipin (aCL) positivity was the only variable significantly associated with IUGR, with an adjusted odds ratio of 4.601 (95% CI, 1.205-17.573). Better pregnant outcomes of aPL positive women, include APS and NCAPS, were achieved in our study with treatment based on low-dose aspirin (LDA) plus low molecular weight heparin (LMWH). The incidence of IUGR was still higher in them, and aCL positivity was the only one risk factor associated with IUGR.

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Section: Discussionmentioning

confidence: 99%

Anticardiolipin Positivity Is Highly Associated With Intrauterine Growth Restriction in Women With Antiphospholipid Syndrome

Cai

et al. 2020

Clin Appl Thromb Hemost

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“…The sample was small. A second retrospective cohort study compared women with non-criteria obstetric APS, who were treated with LDA and heparin, with untreated women; live births occurred in 81.7% and 55% of pregnancies, respectively 80. Because these studies did not focus specifically on the population of interest, evidence for this question is indirect.…”

Section: Obstetric Apsmentioning

confidence: 99%

“…History of delivery ≥ 34 weeks due to eclampsia or severe pre-eclampsia, or placental insufficiency. One study compared 71 women with various non-criteria obstetric APS complications (two consecutive miscarriages <10 weeks, delivery ≥34 weeks, late intrauterine growth restriction, abruption placentae at term or placental haematoma), who were treated with LDA and heparin, with 20 untreated women; live births occurred in 81.7% and 55%, respectively 80. An unknown percentage of women in this study matched the population of interest.…”

Section: Obstetric Apsmentioning

confidence: 99%

Management of thrombotic and obstetric antiphospholipid syndrome: a systematic literature review informing the EULAR recommendations for the management of antiphospholipid syndrome in adults

et al. 2019

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ObjectiveTo perform a systematic literature review (SLR) informing the European Lmmendations for the management of antiphospholipid syndrome (APS) in adults.MethodsA SLR through January 2018 was performed. Research questions were constructed using the Patient, Intervention, Comparator, Outcome (PICO) format. We included data from articles that reported on each relevant intervention. Summary effect estimates were calculated for direct comparison studies that matched the PICO question exactly, and for studies with the relevant intervention and comparator. When meta-analyses were available, we used these estimates.ResultsFrom 7534 retrieved articles (+15 from hand searches), 188 articles were included in the review. In individuals with high-risk antiphospholipid antibody (aPL) profile without prior thrombotic or obstetric APS, two meta-analyses showed a protective effect of low-dose aspirin (LDA) against thrombosis. Two randomised controlled trials (RCTs) and three cohort studies showed no additional benefit of treatment with vitamin K antagonists at target international normalised ratio (INR) 3–4 versus INR 2–3 in patients with venous thrombosis. In patients with arterial thrombosis, two RCTs and two cohort studies showed no difference in risk of recurrent thrombosis between the two target INR groups. One open-label trial showed higher rates of thrombosis recurrences in triple aPL-positive patients treated with rivaroxaban than those treated with warfarin. RCTs and cohort studies showed that combination treatment with LDA and heparin was more effective than LDA alone in several types of obstetric APS. SLR results were limited by the indirect evidence and the heterogeneity of patient groups for some treatments, and only a few high-quality RCTs.ConclusionWell-designed studies of homogeneous APS patient populations are needed.

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“…Growing evidences claim to consider the clinical impact of low level positive aPL antibodies and the necessity to set new cut-off levels, basically—though not exclusively—in obstetric APS (Devreese et al, 2010; Mekinian et al, 2012). The proposal to modify the APS classification criteria, mostly referring to laboratory requirements, is reinforced also by consideration that no differences were observed on obstetric complications, gestational period, arterial and/or venous thrombosis, when comparing pregnant women with aPL-related obstetric complications not fulfilling the Sydney criteria, with those fulfilling them (Arachchillage et al, 2015; Alijotas-Reig et al, 2018). Considering that also atypical (low or non-persistent), aPL antibodies presence may be associated with neurological disorders, such as transient ischemic attacks and migraine, but also epilepsy, transverse myelitis, multiple sclerosis (MS)-like syndrome, visual symptoms, dementia and chorea as well (Islam et al, 2016).…”

Section: Current Challenges In the Diagnosis And Management Of The Anmentioning

confidence: 99%

Antiphospholipid Antibodies Overlapping in Isolated Neurological Syndrome and Multiple Sclerosis: Neurobiological Insights and Diagnostic Challenges

D’Angelo

Franch

Fernández-Paredes

et al. 2019

Front. Cell. Neurosci.

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Antiphospholipid syndrome (APS) is characterized by arterial and venous thrombosis, pregnancy morbidity and fetal loss caused by pathogenic autoantibodies directed against phospholipids (PL) and PL-cofactors. Isolated neurological APS may represent a significant diagnostic challenge, as epidemiological, clinical and neuroimaging features may overlap with those of multiple sclerosis (MS). In an open view, MS could be considered as an organ-specific anti-lipid (phospholipid and glycosphingolipid associated proteins) disease, in which autoreactive B cells and CD8+ T cells play a dominant role in its pathophysiology. In MS, diverse autoantibodies against the lipid-protein cofactors of the myelin sheath have been described, whose pathophysiologic role has not been fully elucidated. We carried out a review to select clinical studies addressing the prevalence of antiphospholipid (aPL) autoantibodies in the so-called MS-like syndrome. The reported prevalence ranged between 2% and 88%, particularly aCL and aβ2GPI, with predominant IgM isotype and suggesting worse MS prognosis. Secondarily, an updated summary of current knowledge on the pathophysiological mechanisms and events responsible for these conditions is presented. We draw attention to the clinical relevance of diagnosing isolated neurological APS. Prompt and accurate diagnosis and antiaggregant and anticoagulant treatment of APS could be vital to prevent or at least reduce APS-related morbidity and mortality.

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Comparative study between obstetric antiphospholipid syndrome and obstetric morbidity related with antiphospholipid antibodies

Cited by 25 publications

References 25 publications

Anticardiolipin Positivity Is Highly Associated With Intrauterine Growth Restriction in Women With Antiphospholipid Syndrome

Anticardiolipin Positivity Is Highly Associated With Intrauterine Growth Restriction in Women With Antiphospholipid Syndrome

Management of thrombotic and obstetric antiphospholipid syndrome: a systematic literature review informing the EULAR recommendations for the management of antiphospholipid syndrome in adults

Antiphospholipid Antibodies Overlapping in Isolated Neurological Syndrome and Multiple Sclerosis: Neurobiological Insights and Diagnostic Challenges

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