scholarly journals AB0295 TREATMENT OF HIGH RISK/REFRACTORY OBSTETRIC ANTIPHOSPHOLIPID SYNDROME. A SINGLE CENTRE EXPERIENCE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1174.1-1174
Author(s):  
A. Hoxha ◽  
P. Marson ◽  
M. Favaro ◽  
M. Tonello ◽  
M. Zen ◽  
...  
Keyword(s):  
High Risk ◽  
Antiphospholipid Syndrome ◽  
Pregnancy Complications ◽  
Low Dose ◽  
Treatment Protocol ◽  
Line Treatment ◽  
Second Line ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
History Of

Background:The most efficacious strategy to manage pregnant patients with antiphospholipid syndrome (APS) who are at high risk of adverse pregnancy outcomes ± refractory to conventional heparin/low-dose aspirin treatment is currently unknown (1, 2).Objectives:The purposes of this study were to investigate the efficacy and safety of a second-line treatment protocol administered in addition to twice daily low molecular weight heparin and low-dose aspirin to pregnant patients affected with high-risk ± refractory primary APS.Methods:Patients were included in the study if satisfying the following criteria were: 1) the presence of triple antiphospholipid antibody positivity (IgG/IgM anticardiolipin + IgG/IgM anti-β2 Glycoprotein I antibodies + lupus anticoagulant), 2) previous thrombosis and/or a history of one or more early and severe pregnancy complications. The second-line treatment protocol included weekly plasmapheresis or immunoadsorption and fortnightly 1g/kg intravenous immunoglobulins.Results:Twenty-four pregnancies occurring between 2002 and 2019 in 19 primary APS patients, (mean age 35.1 ± 3.5 SD) were monitored. Triple antiphospholipid positivity was detected in all 19 cases (100%). Seven of these women (36.8%) had a history of thrombosis, five (26.3%) one or more previous failed pregnancies associated to severe pregnancy complications and seven (36.8%) both clinical criteria. Twenty- three pregnancies (95.8%) produced live neonates (13 females and 10 males), all born between the 26th and 38th week of gestation (mean 33.6 ± 3.5 SD); birth weight percentile was 35.8 ± 24.1 SD and mean Apgar score at 5 min 8.7 ± 1.1 SD. Due to premature birth (24th week) complicated by fetal sepsis, one pregnancy (4.2%) had a negative outcome. During the treated pregnancy there were no episodes of thrombosis; there were five cases (20.8%) of severe maternal complications during pregnancy or puerperium and four of fetal complications (16.6%), all followed by complete recovery after delivery. No side-effects of the treatment were registered.Conclusion:Given the high live birth rate and the safety associated to it, the second-line treatment protocol described here could be taken into consideration when the treatment of a high-risk APS pregnancy ± refractory to conventional therapy is being evaluated.References:[1]Tektonidou MG, et al. Ann Rheum Dis 2019;0:1–9. doi:10.1136/annrheumdis-2019-215213[2]Giacomelli et al. Autoimmun Rev. 2020;102738. doi.org/10.1016/j.autrev.2020.102738Disclosure of Interests:None declared

scholarly journals Digital ischaemia secondary to adalimumab-induced antiphospholipid syndrome

2020 ◽  
Vol 13 (2) ◽  
pp. e232907 ◽  
Author(s):  
Shashank Cheemalavagu ◽  
Sara S McCoy ◽  
Jason S Knight
Keyword(s):  
Antiphospholipid Syndrome ◽  
Low Dose ◽  
Antiphospholipid Antibody ◽  
Antibody Testing ◽  
Left Hand ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
History Of ◽  
Digital Ischaemia ◽  
Necrosis Factor

A 50-year-old woman with a history of Crohn’s disease treated with adalimumab presented with left hand pain and duskiness. Angiogram showed non-filling of the radial and digital arteries of the hand. Antiphospholipid antibody testing was positive, leading to a diagnosis of antitumour necrosis factor-induced antiphospholipid syndrome. Adalimumab was discontinued, and she was treated with the vitamin K antagonist warfarin and low-dose aspirin. Upon resolution of the antiphospholipid antibodies, she was transitioned to aspirin alone without recurrence of thrombosis.

scholarly journals 95 Long-term dual antiplatelet therapy after myocardial infarction in clinical practice: impact of nuisance bleeding on medication adherence

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Gennaro Ratti ◽  
Cristina Di Tommaso ◽  
Cinzia Monda ◽  
Ciro Elettrico ◽  
Federica Ratti ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Medication Adherence ◽  
High Risk ◽  
Low Dose ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
History Of

Abstract Aims Long-term treatment with ticagrelor 60 mg and low-dose aspirin are indicated after acute coronary syndrome (ACS) for the secondary prevention of atherothrombotic events in high-risk patients with a history of myocardial infarction of at least 1 year. Long-term dual antiplatelet therapy (DAPT) had a well tolerability and safety profile, but the risk of TIMI major bleeding was significantly increased. However even nonsignificant bleeding may be important because have an effect on quality of life and therefore may lead to treatment discontinuation. To understand the experiences of patients with long-term DAPT with ticagrelor 60 mg and low-dose aspirin and nuisance bleeding, and their impact of nuisance bleeding on medication adherence. Methods and results We retrospectively reviewed aggregate data of 187 patients (155 M e 38 F) (mean age 63.8 ± 9 years) in follow-up after ACS with at least one high risk condition (multivessel disease, diabetes, GFR < 60 mL/min, history of prior myocardial infarction, age > 65 years) treated with ticagrelor 60 mg twice daily (after 90 mg twice daily for 12 months). The high risk groups were represented as follows: multivessel disease 105 pts (82%), diabetes 63 pts (33%), GFR< 60 mL/min 27 pts (14%), history of prior MI 33 pts (17%), and >65 year aged 85 pts (45%). The outpatient follow-up programme after hospitalization provides visits at day 30 after discharge and subsequently after 3 months, then continuing with 6-monthly checks. The intensity of bleeding was assessed according to the TIMI score.1 Any overt bleeding event that did not meet the criteria of major and minor was defined ‘minimal’. Treatment was withdrawn in seven patients: three cases showed atrial fibrillation and were placed on oral anticoagulant drugs, one developed intracranial bleeding. In three patients, a temporary withdrawal was due to surgery (one colon polyposis and two cases of bladder papilloma). Minimal bleedings (nasal, gingival, conjunctival, subcutaneous/dermal, rectal and urinary) were present in 31 patients, but were not a cause for discontinuation of therapy. However, 22 (70%) subjects had asked opinion on stop the therapy at the telephone consultation. We found that: (i) participants adhered to treatment when they believed long-term DAPT was important to health outcomes; (ii) those who experienced nuisance bleeding reported symptoms to be mild and manageable; (iii) participants’ and their family’s understanding of long-term DAPT risks and benefits, and their ability to manage symptoms, influenced medication adherence. Factors influencing long-term DAPT knowledge included access to medication counselling, engaging with information communicated during medication counselling, and access to timely, relevant and expert information and advice after discharge from hospital. Conclusions All adverse events judged to be ‘not serious’ in trials may have an effect on quality of life and therefore may lead to treatment discontinuation. The need to educate the patient in order to improve adherence should therefore be emphasized. The authors underline the importance of careful outpatient follow-up and constant counselling in order to check out compliance and possible adverse effect of long term DAPT risks treatment.

scholarly journals A Promising Effect of Pravastatin For Reducing Preeclamsia Incidence In High Risk Pregnant Women

2019 ◽  
Vol 1 (1) ◽  
pp. 1-8
Author(s):  
Fariska Zata ◽  
Mohammad Nasir
Keyword(s):  
Cardiovascular Disease ◽  
High Risk ◽  
Pregnant Women ◽  
Low Dose ◽  
Early Prevention ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Definitive Therapy ◽  
History Of

Preeclamsia is still a threat in obstetrics because it is the leading cause of maternal death (15-20% in developing countries). Globally, preeclampsia causes 70,000-80,000 pregnant women to die and 500,000 babies die annually1, with increased morbidity such as prematurity and fetal growth disturbance2. The exact cause of preeclampsia is still not clearly known (also called "The disease of theory"), but recent studies shows that the imbalance of pro-angiogenic (VEGF, PlGF) and anti-angiogenic factors (sFlt-1, s-Eng) plays an important role in the pathogenesis preeclampsia. The presence of general maternal endothelial dysfunction induced by an imbalance of these factors is a major phenomenon in preeclampsia, which results in placental hypoxia / ischemia, resulting in vasoconstriction resulting in hypertension1. Termination of pregnancy is still as a definitive therapy for preeclamsia. Therefore, early prevention is necessary in the management of preeclampsia. In 2013, ACOG recommended the administration of low-dose aspirin and calcium 1 gram / day to patients in pregnant women with high risk of preeclamsia3. However, low-dose aspirin is less useful in preventing preeclampsia in patients with a history of previous chronic hypertension4 and not reduce the incidence of term preeclampsia (the incidence of preeclampsia at gestational age above 37 weeks)5,6. This weakness of low-dose aspirin has led to recent research focusing on the prevention of preeclampsia. The similarity between the pathogenesis mechanism of preeclampsia and cardiovascular disease makes pravastatin (a protective therapy in cardiovascular disease before) as a potential agent for preventing preeclampsia7. Therefore, the role of pravastatin for reducing preeclampsia incidence in high risk pregnant women will be discussed in this article.

scholarly journals Aspirin Use in Rheumatoid Arthritis Patients with Increased Risk of Cardiovascular Disease

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Jonida K. Cote ◽  
Androniki Bili
Keyword(s):  
Rheumatoid Arthritis ◽  
High Risk ◽  
Gastrointestinal Bleeding ◽  
Low Dose ◽  
Cross Sectional ◽  
Dose Aspirin ◽  
Increased Risk ◽  
Low Dose Aspirin ◽  
History Of ◽  
Cad Risk

Objectives. To examine the patterns of low-dose aspirin use in rheumatoid arthritis (RA) patients with high risk for coronary artery disease (CAD). Methods. Cross-sectional study of 36 consecutive RA patients with a Framingham score ≥10% for CAD. Eligible RA patients were provided with a questionnaire on CAD risk factors and use of low-dose aspirin. For aspirin nonusers, the reason for nonuse was requested by both the patient and rheumatologist. Questions for patients included physician's advice, self-preference, history of gastrointestinal bleeding, allergy to aspirin, or concomitant use of other anti-inflammatory medications. Questions for rheumatologists included awareness of the increased CAD risk, attribution, patient preference, history of gastrointestinal bleeding, allergy to aspirin, and medication interactions. Results. Patients participated in the study; 8 patients reported using daily aspirin, while 23 patients did not. The main reason cited by patients for not taking aspirin was that they were not instructed by their primary care physician (PCP) to do so (n=16), which was also the main reason cited by rheumatologists (n=9). Conclusion. This study confirmed underutilization of aspirin in RA patients at high risk for CAD, largely due to the perception that this is an issue which should be handled by the PCP.

scholarly journals Effect of Low-Dose Aspirin on Primary Prevention of Cardiovascular Events in Japanese Diabetic Patients at High Risk

2013 ◽  
Vol 77 (12) ◽  
pp. 3023-3028 ◽  
Author(s):  
Sadanori Okada ◽  
Takeshi Morimoto ◽  
Hisao Ogawa ◽  
Mio Sakuma ◽  
Hirofumi Soejima ◽  
...  
Keyword(s):  
Primary Prevention ◽  
High Risk ◽  
Cardiovascular Events ◽  
Low Dose ◽  
Diabetic Patients ◽  
Dose Aspirin ◽  
Low Dose Aspirin

scholarly journals Evidence-Based Prevention of Preeclampsia: Commonly Asked Questions in Clinical Practice

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Dagmar Wertaschnigg ◽  
Maya Reddy ◽  
Ben W. J. Mol ◽  
Fabricio da Silva Costa ◽  
Daniel L. Rolnik
Keyword(s):  
High Risk ◽  
Low Dose ◽  
Recent Literature ◽  
Calcium Supplementation ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Daily Dose ◽  
Risk Patients ◽  
Routine Antenatal Care ◽  
Risk Of Preeclampsia

In this review, we discuss the recent literature regarding the prevention of preeclampsia and aim to answer common questions that arise in the routine antenatal care of pregnant women. Prescription of low-dose aspirin for high-risk patients has been shown to reduce the risk of preeclampsia (PE). A daily dose between 100 and 150 mg taken in the evening should be initiated prior to 16 weeks of gestation and can be continued until delivery. Calcium supplementation seems to be advantageous but currently it is only considered for patients with poor dietary intake and high risk for PE. Recent data about heparin are still conflicting, and therefore, heparin can currently not be recommended in the prevention of PE.

Maternal serum thromboxane B2 concentrations do not predict improved outcomes in high-risk pregnancies in a low-dose aspirin trial

1998 ◽  
Vol 179 (5) ◽  
pp. 1193-1199 ◽  
Author(s):  
John Hauth ◽  
Baha Sibai ◽  
Steve Caritis ◽  
Peter VanDorsten ◽  
Marshall Lindheimer ◽  
...  
Keyword(s):  
High Risk ◽  
Low Dose ◽  
Maternal Serum ◽  
Thromboxane B2 ◽  
Dose Aspirin ◽  
Improved Outcomes ◽  
Low Dose Aspirin ◽  
Serum Thromboxane
Sign in / Sign up

Export Citation Format

Share Document