The relation between antiphospholipid syndrome-related pregnancy morbidity and non-gravid vascular thrombosis: A review of the literature and management strategies

Abstract

The antiphospholipid syndrome (APS) is associated with pregnancy morbidity and vascular thrombosis in the presence of circulating antiphospholipid (aPL) antibodies. Clinical manifestations of aPL antibodies represent a spectrum (asymptomatic, pregnancy events, vascular events, or both pregnancy and vascular events), and APS should not be considered a single disease with a predictable outcome. Patients with aPL antibodies are at increased risk of vascular thrombotic events during pregnancy, the postpartum period, and even during long-term follow-up after an APS-related pregnancy event. Therefore, the purpose of this paper is to review the relation between APS-related pregnancy morbidity and vascular thrombosis, and to address the importance of prophylactic therapy during and after APS pregnancies to prevent maternal thrombotic complications. During pregnancy, low-dose aspirin (LDA) should be considered for all patients with aPL antibodies and heparin should be added to LDA in patients fulfilling the Sapporo criteria for definite APS. During delivery, especially with caesarian section, periods without anticoagulation should be kept to an absolute minimum. Some data suggest that LDA might be effective against future non-gravid vascular thrombosis in patients with APS and a history of only pregnancy morbidity.

Primary Antiphospholipid Syndrome Presenting as HELLP Syndrome

“…Although management of aPL-positive patients is controversial because of limited well-designed controlled trials, several points need to be emphasized [14]: (1) corticosteroids are not indicated in the management of Sapporo APS classification criteria Clinical criteria 1. Vascular thrombosis One or more clinical episodes of arterial, venous, or small vessel thrombosis in any tissue or organ 2.…”

Antiphospholipid Syndrome in Pregnancy

“…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) .…”

Stage 1 chronic kidney disease in pregnancy

“…anticardiolipin, lupus anticoagulant) which may be associated with spontaneous fetal loss of 50-75%, hypertensive syndromes indistinguishable from pre-eclampsia and thrombotic events including deep vein thrombosis, pulmonary embolus, myocardial infarction and strokes. 32 Thus all women with systemic lupus erythematosus should be screened for antiphospholipid antibodies prior to pregnancy or early in gestation. When titres are elevated (more than 40 GPL), daily aspirin (80 -325 mg) is recommended and low molecular weight heparin is generally prescribed.…”