Review : Obstetric outcome in antiphospholipid syndrome

Granger, KA; Farquharson, R. G.

doi:10.1177/096120339700600606

Cited by 81 publications

(42 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…There were 15 studies (447 pregnancies) 27,29,30,37,42,43,60,62,66,79,80,87,88,93,97 in which the principal indication was prevention of RPL and 5 studies (88 pregnancies) 50,[69][70][71]96 in which LMWH was used to prevent preeclampsia, fetal growth restriction, or another adverse pregnancy outcome. The studies were heterogeneous with regard to whether coexistent thrombophilia was present.…”

Section: Lmwh For Prevention Of Adverse Pregnancy Outcomementioning

confidence: 99%

Low-molecular-weight heparins for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: a systematic review of safety and efficacy

Greer

Nelson‐Piercy

2005

Blood

741

422

View full text Add to dashboard Cite

To assess the safety and efficacy of lowmolecular-weight heparins (LMWHs) for thromboprophylaxis and treatment of venous thromboembolism (VTE) in pregnancy, a systematic review of studies to the end of 2003 was undertaken. Data on VTE recurrence and side effects were extracted and cumulative incidences of VTE and adverse effects calculated. Of 81 reports identified, 64 reporting 2777 pregnancies were included. In 15 studies (174 patients) the indication for LMWH was treatment of acute VTE, and in 61 studies (2603 pregnancies) it was thromboprophylaxis or adverse pregnancy outcome. There were no maternal deaths. VTE and arterial thrombosis (associated with antiphospholipid syndrome) were reported in 0.86% (95% confidence interval [CI], 0.55%-1.28%) and 0.50% (95% CI, 0.28%-0.84%) of pregnancies, respectively. Significant bleeding, generally associated with primary obstetric causes, occurred in 1.98% (95% CI, 1.50%-2.57%), allergic skin reactions in 1.80% (95% CI, 1.34%-2.37%), heparin-induced thrombocytopenia in 0%, thrombocytopenia (unrelated to LMWH) in 0.11% (95% CI, 0.02%-0.32%), and osteoporotic fracture in 0.04% (95% CI, < 0.01%-0.20%) of pregnancies. Overall, live births were reported in 94.7% of pregnancies, including 85.4% in those receiving LMWH for recurrent pregnancy loss. LMWH is both safe and effective to prevent or treat VTE in pregnancy. IntroductionPulmonary embolism (PE) remains the leading cause of direct maternal death in the United Kingdom 1 and venous thromboembolism (VTE) in pregnancy is an important cause of morbidity, not only in pregnancy but also in the long term. 2 Effective primary prevention and acute management of VTE in pregnancy are therefore important to reduce maternal mortality and morbidity. Coumarins cross the placenta and their use in pregnancy is associated with significant fetal and maternal risks, related particularly to teratogenesis and hemorrhage. 3 For many years, unfractionated heparin (UFH) was the standard anticoagulant used in pregnancy. 4 Low-molecular-weight heparins (LMWHs) have replaced UFH for the prevention and management of acute VTE without pregnancy. 5,6 In the United Kingdom, Europe, and Australasia, LMWHs are now also widely used for the prevention and treatment of VTE in pregnancy. 7,8 The advantages of LMWHs over UFH include an enhanced ratio of anti-Xa (antithrombotic) to anti-IIa (anticoagulant), resulting in a reduced risk of bleeding; stable and predictable pharmacokinetics with increased bioavailability and half-life, allowing less frequent fixed or weight-based dosing without the need for monitoring; subcutaneous administration 8 ; and less activation of platelets, with less binding to platelet factor 4 substantially reducing the risk of heparin-induced thrombocytopenia (HIT). 9,10 A major concern with the widespread use of UFH in pregnancy has been the 2% risk of symptomatic heparininduced osteoporotic fracture in pregnancy. 9 LMWHs are associated with a lower risk of this devastating complication. [11][12][13] Peer-reviewed international guid...

show abstract

Section: Lmwh For Prevention Of Adverse Pregnancy Outcomementioning

confidence: 99%

Low-molecular-weight heparins for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: a systematic review of safety and efficacy

Greer

Nelson‐Piercy

2005

Blood

741

422

View full text Add to dashboard Cite

show abstract

“…A high incidence of spontaneous abortion, preeclampsia, intrauterine growth retardation and stillbirth has been reported (Hauser et al, 1980;Derksen, 1991;Wong et al, 1991;Kleinman et al, 1998;Johns et al, 1998;Aggarwal et al, 1999). These findings are particularly exacerbated in the presence of antiphospholipid antibodies (Lockshin et al, 1985;Ogasawara et al, 1995;Granger, 1997). A poor perinatal outcome is reported in the presence of active nephritis, impaired renal function and hypertension at the time of the conception (Varner et al, 1983).…”

Section: Introductionmentioning

confidence: 99%

Pregnancy outcome in women with pre-existing lupus nephritis

Soubassi

Haidopoulos

Sindos

et al. 2004

Journal of Obstetrics and Gynaecology

View full text Add to dashboard Cite

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.

show abstract

“…Additionally, two other studies showed no difference in perinatal outcomes when UFH was compared with the use of LMWH (both combined with aspirin) [31,32]. Finally, several observational studies reported success rates of 79% to 100% with isolated lowdose aspirin [28,[33][34][35][36][37][38]. Despite the controversy, a 2005 Cochrane systematic review concluded that women with recurrent miscarriage and APS should be treated with UFH, 5,000 IU twice daily, and low-dose aspirin [39].…”

Section: Embryonic Loss or Early Miscarriagementioning

confidence: 99%

Management of Obstetric Antiphospholipid Syndrome

de Jesus,

dos Santos,

Oliveira

et al. 2011

Curr Rheumatol Rep

View full text Add to dashboard Cite

Recurrent early miscarriages (excluding chromosomal anomalies), late fetal loss, and maternal thrombosis are characteristic of obstetric antiphospholipid syndrome (APS). Obstetric complications such as preeclampsia, fetal growth restriction, premature delivery, and fetal death also occur in higher frequency in APS patients than in the general population. A high-risk obstetric center is needed for proper evaluation of and intervention with pregnant women with APS. Association with lupus carries additional risk of thrombosis when antiphospholipid antibodies (aPLs) are present. Gestational results with live births are improved to about 80% when antithrombotic therapy is used, but failure in 20% to 30% of the cases despite correct treatment with low-dose aspirin with or without heparin reveals new pathways for pregnancy loss in APS and unmet needs. At the moment, there is no recommendation to investigate patients with infertility for the presence of aPLs.

show abstract

Review : Obstetric outcome in antiphospholipid syndrome

Cited by 81 publications

References 16 publications

Low-molecular-weight heparins for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: a systematic review of safety and efficacy

Low-molecular-weight heparins for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: a systematic review of safety and efficacy

Pregnancy outcome in women with pre-existing lupus nephritis

Management of Obstetric Antiphospholipid Syndrome

Contact Info

Product

Resources

About