Karen Schreiber1, Massimo Radin, Savino Sciascia. 1. aThrombosis and Thrombophilia, Guy's and St Thomas' Hospital, London, UK bCopenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark cDepartment of Clinical and Biological Sciences, University of Turin, S. Giovanni Bosco Hospital, Center of Research of Immunopathology and Rare Diseases - Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley dDepartment of Clinical and Biological Sciences, University of Turin, S. Giovanni Bosco Hospital, Nephrology and Dialysis Unit, Turin, Italy.
Abstract
PURPOSE OF REVIEW: Antiphospholipid syndrome (APS) is defined as the association of thrombotic events and/or obstetric morbidity in patients persistently positive for antiphospholipid antibodies (aPL). In this review, we will highlight the most important clinical presentations of APS with a focus on the obstetric morbidity, the current management strategies and the outlook for the future. RECENT FINDINGS: The use of aspirin and heparin has improved the pregnancy outcome in obstetric APS and approximately 70% of pregnant women with APS have a successful pregnancy outcome. Unfortunately, the current standard of care does not prevent all pregnancy complications as the current treatment fails in 20-30% of APS pregnancies. This therefore highlights the need for alternative treatments to improve obstetrical outcome. Other treatment options are currently explored and retrospective studies show that pravastatin for example is beneficial in women with aPL-related early preeclampsia. Moreover, the immunmodulator hydroxychloroquine may play a beneficial role in the prevention of aPL-related pregnancy complications. SUMMARY: APS is among the most frequent acquired risk factors for a treatable cause of recurrent pregnancy loss and increases the risk of conditions associated with ischaemic placental dysfunction, such as fetal growth restriction, preeclampsia, premature birth and intrauterine death. Current treatment is mainly based on aspirin and heparin. Studies to inform on alternative treatment options are urgently needed.
PURPOSE OF REVIEW: Antiphospholipid syndrome (APS) is defined as the association of thrombotic events and/or obstetric morbidity in patients persistently positive for antiphospholipid antibodies (aPL). In this review, we will highlight the most important clinical presentations of APS with a focus on the obstetric morbidity, the current management strategies and the outlook for the future. RECENT FINDINGS: The use of aspirin and heparin has improved the pregnancy outcome in obstetric APS and approximately 70% of pregnant women with APS have a successful pregnancy outcome. Unfortunately, the current standard of care does not prevent all pregnancy complications as the current treatment fails in 20-30% of APS pregnancies. This therefore highlights the need for alternative treatments to improve obstetrical outcome. Other treatment options are currently explored and retrospective studies show that pravastatin for example is beneficial in women with aPL-related early preeclampsia. Moreover, the immunmodulator hydroxychloroquine may play a beneficial role in the prevention of aPL-related pregnancy complications. SUMMARY: APS is among the most frequent acquired risk factors for a treatable cause of recurrent pregnancy loss and increases the risk of conditions associated with ischaemic placental dysfunction, such as fetal growth restriction, preeclampsia, premature birth and intrauterine death. Current treatment is mainly based on aspirin and heparin. Studies to inform on alternative treatment options are urgently needed.
Authors: G R de Jesús; S Sciascia; D Andrade; M Barbhaiya; M Tektonidou; A Banzato; V Pengo; L Ji; P L Meroni; A Ugarte; H Cohen; D W Branch; L Andreoli; H M Belmont; P R Fortin; M Petri; E Rodriguez; R Cervera; J S Knight; T Atsumi; R Willis; I S Nascimento; R Rosa; D Erkan; R A Levy Journal: BJOG Date: 2018-10-24 Impact factor: 6.531
Authors: Daniel E Pleguezuelo; Oscar Cabrera-Marante; Magdalena Abad; Edgard Alfonso Rodriguez-Frias; Laura Naranjo; Alicia Vazquez; Olga Villar; Francisco Javier Gil-Etayo; Manuel Serrano; Alfredo Perez-Rivilla; Laura de la Fuente-Bitaine; Antonio Serrano Journal: J Clin Med Date: 2021-05-13 Impact factor: 4.241
Authors: Ilan Volkov; Luciana Seguro; Elaine P Leon; László Kovács; Dirk Roggenbuck; Peter Schierack; Boris Gilburd; Andrea Doria; Maria G Tektonidou; Nancy Agmon-Levin Journal: Auto Immun Highlights Date: 2020-05-15