Management of Women with Antiphospholipid Antibodies or Antiphospholipid Syndrome during Pregnancy

Abstract

Antiphospholipid syndrome (APS), which is characterized by the presence of antiphospholipid antibodies (aPL), is associated with increased risk of thrombosis and obstetric complications, including preterm delivery and recurrent pregnancy losses. APS shows diverse clinical manifestations and the risk of complications varies among clinical subtypes. Although these patients are usually treated with aspirin and anticoagulants, the optimal treatment in various clinical settings is unclear, as the risk of complications vary among clinical subtypes and the management strategy depends on whether the patient is pregnant or not. Also, there are unmet needs for the evidence-based, pregnancyrelated treatment of asymptomatic women positive for aPL. This review focuses on the management of positive aPL or APS in pregnant and postpartum women, and in women attempting to become pregnant. For asymptomatic aPL positive women, no treatment, low dose aspirin (LDA) or LDA plus anticoagulants can be considered during antepartum and postpartum. In obstetric APS patients, preconceptional LDA is recommended. LDA plus low molecular weight heparin is administered after confirmation of pregnancy. Vascular APS patients should take frequent pregnancy test and receive heparin instead of warfarin after confirmation of pregnancy. During pregnancy, heparin plus LDA is recommended. Warfarin can be restarted 4 to 6 hours after vaginal delivery and 6 to 12 hours after cesarean delivery. Most importantly, a tailored approach and patient-oriented treatment are mandatory.

Protection by hydroxychloroquine prevents placental injury in obstetric antiphospholipid syndrome

“…APS patients are often complicated with other immune diseases, and IgG antibodies in the body are diverse and highly heterogeneous. 2,38 Compared with IgG extracted from the patients' blood, we used anti-β2GPI Ab, which has a single component and a strong repeatability, and there is no interference of specimen heterogeneity.…”

Pr-AKI: Acute Kidney Injury in Pregnancy – Etiology, Diagnostic Workup, Management

“…B. Thrombose, Lungenarterienembolie) ist neben ASS niedermolekulares Heparin (z. B. Enoxaparin) je nach Risikoprofil zur prophylaktischen oder therapeutischen Antikoagulation anzuwenden 83 , 84 , 85 . Cumarin-Derivate wie z.…”

“…Depending on the risk profile, patients with additional known antiphospholipid syndrome or who have already experienced complications (e.g., thrombosis, pulmonary artery embolism) should be administered low-molecular-weight heparin (e.g., enoxaparin) in addition to ASA for prophylactic or therapeutic anticoagulation 83 , 84 , 85 . Because of their teratogenic effect, coumarin derivates such as phenprocoumon or warfarin should be replaced by more suitable alternatives, whenever possible.…”

A Brief Analysis of Tissue-Resident NK Cells in Pregnancy and Endometrial Diseases: The Importance of Pharmacologic Modulation

“…Patients with antiphospholipid antibodies and with thrombotic pathologies are treated with heparin during pregnancy. There are several hypotheses on the possible mechanisms of heparin; however, none of them involved NK cell response [118,119]. Thus, heparin's role in preventing thrombotic events may be crucial for the embryo or fetal survival.…”

“…Thus, heparin's role in preventing thrombotic events may be crucial for the embryo or fetal survival. The use of heparin as an immunomodulator is complicated to envision; however, the effect of heparin binding to receptors on different cell types and modulating cellular processes may, in turn, affect NK cell response [118,119]. Therefore, more research should be performed to ascertain the possible effect of this and other glycosaminoglycans on NK cell function.…”