Production of prostacyclin and thromboxane in lupus pregnancies: Effect of small dose of aspirin

Kaaja, Risto; Julkunen, Heikki; Viinikka, L; Ylikorkala, O.

doi:10.1016/0020-7292(93)90340-3

Cited by 19 publications

(20 citation statements)

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“…Patients positive for antiphospholipid antibodies were given aspirin or low molecular weight heparin and aspirin in addition to prednisolone treatment during pregnancy in our study. Anticoagulant treatment has been shown to result in successful pregnancy outcome (Kaaha et al, 1993;Piette, 1998). Antiphospholipid antibodies are thought to promote thrombosis upon interaction with platelet or endothelial membrane phospholipids and both aspirin and heparin may be of value in these patients during pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy outcome in women with pre-existing lupus nephritis

Soubassi

Haidopoulos

Sindos

et al. 2004

Journal of Obstetrics and Gynaecology

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The aim of the present study was to assess the fetal and maternal outcome in a cohort of patients with lupus nephritis. Twenty-four pregnancies in 22 women with lupus nephritis occurring between 1991 and 2000 were analysed retrospectively. Lupus nephritis was biopsy proven before pregnancy in all cases. Women were followed from the beginning of pregnancy up to 6 months postpartum. Close fetal-maternal monitoring and frequent laboratory investigations were applied routinely to all patients. All women were prescribed steroid therapy from the beginning of the pregnancy. There were 18 live births, four spontaneous abortions and two stillbirths. Of the 18 live births, 14 were premature and four were term deliveries, representing a 25% fetal loss rate and 58% prematurity rate. There were two fetuses with congenital heart block. We recorded hypertension in 42%, proteinuria in 50% and pre-eclampsia in 25% of our patients. Proteinuria was irreversible in four cases. No maternal deaths or postpartum exacerbation of the disease were recorded in the study period. All renal flares were reversed postpartum. Patients positive for antiphospholipid antibodies had a worse perinatal outcome. Hypertension, proteinuria and antiphospholipid antibodies appear to be associated with adverse perinatal outcome and pregnancy complications. Pregnancy is not contraindicated in women with lupus nephritis, but is associated with significant fetal and maternal risks.

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Section: Discussionmentioning

confidence: 99%

Pregnancy outcome in women with pre-existing lupus nephritis

Soubassi

Haidopoulos

Sindos

et al. 2004

Journal of Obstetrics and Gynaecology

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“…It is also possible that part of the effect of aspirin on thrombosis prophylaxis in APLA patients relies on platelet thromboxane inhibition. It has been shown that the urine of APLA patients has increased quantities of thromboxane metabolites [26,27] and that purified APLA increase platelet thromboxane production after minimal thrombin stimulation in vitro [28]. However, the ability of APLA to activate platelets directly is still debated, since, for example, incubation with APS sera resulted in an increase of platelet-associated IgG without any clear activation in one study [29].…”

Section: Discussionmentioning

confidence: 99%

Aspirin inhibits endothelial cell activation induced by antiphospholipid antibodies

Dunoyer‐Geindre

Kruithof

Boehlen

et al. 2004

Journal of Thrombosis and Haemostasis

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Summary. Background: Antiphospholipid antibodies (APLA) have been shown to activate endothelial cells (EC) in vitro, as documented by an increased expression of tissue factor as well as leukocyte adhesion molecules such as intercellular adhesion molecule-1, vascular cell adhesion molecule (VCAM)-1 and E-selectin. Currently, treatment of patients with the antiphospholipid syndrome includes aspirin, particularly for women with recurrent fetal loss. Objective: The present study was undertaken to investigate whether aspirin interferes with EC activation induced by APLA in vitro. Methods: IgG from 14 patients with APLA, and suffering from thrombotic complications and/or pregnancy morbidity, and control IgG were tested for their ability to modify the expression of VCAM-1 in human umbilical vein endothelial cells. VCAM-1 antigen was measured by flow cytometry and its mRNA by quantitative reverse transcriptase-polymerase chain reaction. Results: Incubation of EC with IgG from most of the patients led to a higher VCAM-1 expression compared with incubation with control IgG. The effect of aspirin was studied for the eight IgG samples that induced a more than 50% increase in VCAM-1. Aspirin (10 mM) treatment of the cells significantly reduced the VCAM-1 response to these APLA. Conclusions: Our results indicate that besides its antiplatelet properties, aspirin exerts a protective effect towards APLA at the EC level by decreasing leukocyte adhesion molecule expression at the cell surface.

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“…Prostacyclin and TxA2 outputs are most reliably assessed by assay of their stable urinary metabolites (FitzGerald et al , 1987a). Increased thromboxane biosynthesis in normal pregnancy (FitzGerald et al , 1987b) and in thrombophilic women during pregnancy is derived mainly from platelets, as low‐dose aspirin, a selective platelet COX‐1 inhibitor, can abolish its synthesis (Kaaja et al , 1993).…”

Section: Discussionmentioning

confidence: 99%

Increased thromboxane production in women with a history of venous thromboembolic event: effect of heparins

Kaaja¹,

Pettilä²,

Leinonen³

et al. 2001

Br J Haematol

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Summary. We investigated the production of prostacyclin and thromboxane in pregnant women with a previous venous thromboembolic event before, during and after the use of unfractionated heparin and low molecular weight heparin (dalteparin). Twenty women were studied before starting heparin prophylaxis (before 20 weeks of gestation), during heparin prophylaxis (at 30 weeks of gestation) and after heparin prophylaxis (16 weeks after delivery). Ten pregnant women with no history of thromboembolism were studied as the control group. Urinary output of the stable metabolite of prostacyclin (2,3-dinor-6-keto-PGF1a) and that of thromboxane A2 (2,3-dinor-TxB2), as well as a number of markers of thrombophilia were measured and expressed as mean (^SEM). Women with a history of thromboembolism were characterized by normal prostacyclin production but elevated thromboxane production (44´0^4´1 versus 19´0^3´6 ng/mmol creatinine, P , 0´001) at 12 weeks of pregnancy. Heparin prophylaxis (regardless of the type) had abolished elevated thromboxane concentrations at 30 weeks of gestation. Four months after delivery, thromboxane dominance had returned (25´2^3´5 versus 13´6^2´1 ng/mmol creatinine, P , 0´01). The presence of hereditary thrombophilia (9/ 20) was not associated with any changes in prostanoid concentrations. Thus, women with a history of venous thromboembolic events have thromboxane dominance during and after pregnancy, but this dominance can be eliminated through the use of heparins.

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Production of prostacyclin and thromboxane in lupus pregnancies: Effect of small dose of aspirin

Cited by 19 publications

References 0 publications

Pregnancy outcome in women with pre-existing lupus nephritis

Pregnancy outcome in women with pre-existing lupus nephritis

Aspirin inhibits endothelial cell activation induced by antiphospholipid antibodies

Increased thromboxane production in women with a history of venous thromboembolic event: effect of heparins

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