Management of the obstetric antiphospholipid syndrome

Derksen, R. H. W. M.; Khamashta, Munther A.; Branch, D. Ware

doi:10.1002/art.20105

Cited by 186 publications

(84 citation statements)

References 67 publications

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“…In addition to recurrent miscarriage and fetal death, pregnancy complications in women with APS include preeclampsia, placental insufficiency, and fetal growth restriction (Wilson et al, 1999;Lockshin et al, 2000;Levine et al, 2002). The pathogenic mechanisms that lead to injury in vivo are incompletely understood and therapy for pregnant women with APS, currently aimed at preventing thrombosis (Levine et al, 2002;Derksen et al, 2004), is only partially successful in averting pregnancy loss.…”

Section: Introductionmentioning

confidence: 99%

Antiphospholipid antibodies and pregnancy loss: a disorder of inflammation

Salmon

Girardi

2008

Journal of Reproductive Immunology

118

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The antiphospholipid syndrome (APS) is a leading cause of miscarriage and maternal and fetal morbidity. APS is characterized by thrombosis and pregnancy loss that occur in the presence of antiphospholipid (aPL) antibodies. Using a mouse model of APS induced by passive transfer of human aPL antibodies, we have shown that complement activation plays an essential and causative role in pregnancy loss and fetal growth restriction, and that blocking activation of the complement cascade rescues pregnancies. Conventional treatment for APS patients is sub-anticoagulant doses of heparin throughout pregnancy. Could heparin prevent pregnancy loss by inhibiting complement? In our experimental model of APS, heparin inhibits activation of complement on trophoblasts in vivo and in vitro, and anticoagulation in and of itself is not sufficient to prevent pregnancy complications. These studies underscore the importance of inflammation in fetal injury associated with aPL antibodies and raise the importance of developing and testing targeted complement inhibitory therapy for patients with APS.

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Section: Introductionmentioning

confidence: 99%

Antiphospholipid antibodies and pregnancy loss: a disorder of inflammation

Salmon

Girardi

2008

Journal of Reproductive Immunology

118

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“…Therefore, it is desirable to continue LMWH during labor or delivery in women receiving antenatal thromboprophylaxis (21) . The duration of recommendations range from 3-5 days (21) , to 6-8 weeks (76) and up to 12 weeks (77) .…”

Section: Therapeutic Optionsmentioning

confidence: 99%

Antiphospholipid Syndrome in Pregnancy

Haram¹,

Jacobsen²,

Sandset³

2012

Antiphospholipid Syndrome

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“…A recent systematic review recommended a target INR > 3 in the group of patients with APS and arterial or recurrent venous thrombosis [4]. The approach for women with obstetric manifestations of APS is based on the use of aspirin plus heparin [5]. However, intensive research during the last 25 years on the pathogenic mechanisms of the aPL is now leading to the proposal of several new therapeutic strategies based on targeted therapies, that are extensively reviewed in another article in this issue [6].…”

Section: Introductionmentioning

confidence: 99%