Antiphospholipid Syndrome and Recurrent Miscarriage

2011 ◽  
pp. 9-9
Author(s):  
Shalini Rajaram ◽  
Bindiya Gupta
Keyword(s):  
Antiphospholipid Syndrome ◽  
Recurrent Miscarriage

scholarly journals Maternal Thrombophilia and Recurrent Miscarriage – Is There Evidence That Heparin is Indicated as Prophylaxis against Recurrence?

2018 ◽  
Vol 78 (03) ◽  
pp. 274-282 ◽  
Author(s):  
Ana-Luisa Stefanski ◽  
Christoph Specker ◽  
Rebecca Fischer-Betz ◽  
Wolfgang Henrich ◽  
Ekkehard Schleussner ◽  
...  
Keyword(s):  
Spontaneous Abortion ◽  
Antiphospholipid Syndrome ◽  
Low Dose ◽  
Recurrent Miscarriage ◽  
Current Data ◽  
Recurrent Spontaneous Abortion ◽  
Thrombosis Prophylaxis ◽  
Special Focus ◽  
Maternal Risk ◽  
Hereditary Thrombophilia

Abstract Background Recurrent miscarriage, also referred to as recurrent spontaneous abortion (RSA), affects 1 – 5% of couples and has a multifactorial genesis. Acquired and congenital thrombophilia have been discussed as hemostatic risk factors in the pathogenesis of RSA. Method This review article was based on a selective search of the literature in PubMed. There was a special focus on the current body of evidence studying the association between RSA and antiphospholipid syndrome and hereditary thrombophilia disorders. Results Antiphospholipid syndrome (APS) is an acquired autoimmune thrombophilia and recurrent miscarriage is one of its clinical classification criteria. The presence of lupus anticoagulant has been shown to be the most important serologic risk factor for developing complications of pregnancy. A combination of low-dose acetylsalicylic acid and heparin has shown significant benefits with regard to pregnancy outcomes and APS-related miscarriage. Some congenital thrombophilic disorders also have an increased associated risk of developing RSA, although the risk is lower than for APS. The current analysis does not sufficiently support the analogous administration of heparin as prophylaxis against miscarriage in women with congenital thrombophilia in the same way as it is used in antiphospholipid syndrome. The data on rare, combined or homozygous thrombophilias and their impact on RSA are still insufficient. Conclusion In contrast to antiphospholipid syndrome, the current data from studies on recurrent spontaneous abortion do not support the prophylactic administration of heparin to treat women with maternal hereditary thrombophilia in subsequent pregnancies. Nevertheless, the maternal risk of thromboembolic events must determine the indication for thrombosis prophylaxis in pregnancy.

Prevention of recurrent miscarriage in women with antiphospholipid syndrome: A systematic review and network meta-analysis

Lupus ◽  
2020 ◽  
Vol 30 (1) ◽  
pp. 70-79
Author(s):  
Ziyi Yang ◽  
Xiangli Shen ◽  
Chuqing Zhou ◽  
Min Wang ◽  
Yi Liu ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Antiphospholipid Syndrome ◽  
Live Birth ◽  
Birth Rate ◽  
Recurrent Miscarriage ◽  
Live Birth Rate ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Pharmacological Interventions ◽  
Significant Difference

Objectives To compare and rank currently available pharmacological interventions for the prevention of recurrent miscarriage (RM) in women with antiphospholipid syndrome (APS). Methods A search was performed using PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, CNKI, ClinicalTrials.gov, and the UK National Research Register on December 15, 2019. Studies comparing any types of active interventions with placebo/inactive control or another active intervention for the prevention of RM in patients with APS were considered for inclusion. The primary outcomes were efficacy (measured by live birth rate) and acceptability (measured by all-cause discontinuation); secondary outcomes were birthweight, preterm birth, preeclampsia, and intrauterine growth retardation. The protocol of this study was registered with Open Science Framework (DOI: 10.17605/OSF.IO/B9T4E). Results In total, 54 randomized controlled trials (RCTs) comprising 4,957 participants were included. Low-molecular-weight heparin (LMWH) alone, aspirin plus LMWH or unfractionated heparin (UFH), aspirin plus LMWH plus intravenous immunoglobulin (IVIG), aspirin plus LMWH plus IVIG plus prednisone were found to be effective pharmacological interventions for increasing live birth rate (ORs ranging between 2.88 to 11.24). In terms of acceptability, no significant difference was found between treatments. In terms of adverse perinatal outcomes, aspirin alone was associated with a higher risk of preterm birth than aspirin plus LMWH (OR 3.92, 95% CI 1.16 to 16.44) and with lower birthweight than LMWH (SMD −808.76, 95% CI −1596.54 to −5.07). Conclusions Our findings support the use of low-dose aspirin plus heparin as the first-line treatment for prevention of RM in women with APS, and support the efficacy of hydroxychloroquine, IVIG, and prednisone when added to current treatment regimens. More large-scale, high-quality RCTs are needed to confirm these findings, and new pharmacological options should be further evaluated.

P-092: Immunomodulatory effect of intravenous immunoglobin in women with antiphospholipid syndrome and recurrent miscarriage

2017 ◽  
Vol 151 ◽  
pp. S137
Author(s):  
A.A. Chugunova ◽  
M.S. Zainulina ◽  
S.A. Selkov ◽  
S.V. Chepanov ◽  
A.V. Selutin ◽  
...  
Keyword(s):  
Antiphospholipid Syndrome ◽  
Recurrent Miscarriage ◽  
Immunomodulatory Effect

C0527: Circulating Procoagulant Cell-Derived Microparticles in Women with Recurrent Miscarriage Associated with the Antiphospholipid Syndrome

2014 ◽  
Vol 133 ◽  
pp. S27
Author(s):  
D. Tassies ◽  
L. Martin ◽  
M.A. Martinez-Zamora ◽  
E. Garcia ◽  
J. Monteagudo ◽  
...  
Keyword(s):  
Antiphospholipid Syndrome ◽  
Recurrent Miscarriage

Thrombin activatable fibrinolysis inhibitor and clot lysis time in women with recurrent miscarriage associated with the antiphospholipid syndrome

2010 ◽  
Vol 94 (6) ◽  
pp. 2437-2440 ◽  
Author(s):  
M. Angeles Martínez-Zamora ◽  
Montserrat Creus ◽  
Dolors Tassies ◽  
Albert Bové ◽  
Juan Carlos Reverter ◽  
...  
Keyword(s):  
Antiphospholipid Syndrome ◽  
Recurrent Miscarriage ◽  
Clot Lysis ◽  
Thrombin Activatable Fibrinolysis Inhibitor ◽  
Lysis Time ◽  
Fibrinolysis Inhibitor ◽  
Clot Lysis Time

scholarly journals Antiphospholipid syndrome and pregnancy

2012 ◽  
Vol 153 (31) ◽  
pp. 1207-1218
Author(s):  
Klára Gadó ◽  
Gyula Domján
Keyword(s):  
Antiphospholipid Syndrome ◽  
Intrauterine Growth Restriction ◽  
Recurrent Miscarriage ◽  
Fetal Distress ◽  
Normal Pregnancy ◽  
Healthy Children ◽  
Thromboembolic Events ◽  
Thrombotic Risk ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic

Antiphospholipid syndrome is characterized by arterial and venous thromboembolic events and persistent laboratory evidence of antiphospholipid antibodies. Obstetric complications such as recurrent miscarriage, early delivery, oligohydramnios, prematurity, intrauterine growth restriction, fetal distress, fetal or neonatal thrombosis, pre-eclampsia/eclampsia, and HELLP syndrome are also hallmarks of antiphospholipid syndrome. This syndrome is one of the diseases associated with the most severe thrombotic risk. Changes in the hemostatic system during normal pregnancy also result in a hypercoagulable state resulting in elevated thrombotic risk. Thromboembolic events are responsible of the vast majority of maternal and fetal deaths. Administration of appropriate thromboprophylaxis helps prevent thromboembolic complications during pregnancy in women with antiphospholipid syndrome and also give birth to healthy children. It is important to centralize the medication and management of these patients. It helps in the thoughtful care of these pregnant women encountering serious problems. Orv. Hetil., 2012, 153, 1207–1218.

High Affinity Autoantibodies to ADAMTS13 in the Antiphospholipid Syndrome.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 1467-1467
Author(s):  
Steven K. Austin ◽  
Richard D. Starke ◽  
Gordon Purdy ◽  
Andrew S. Lawrie ◽  
Samuel J. Machin ◽  
...  
Keyword(s):  
Antiphospholipid Syndrome ◽  
Recurrent Miscarriage ◽  
Anticardiolipin Antibody ◽  
Autoimmune Disorder ◽  
Activity Levels ◽  
Adamts13 Activity ◽  
Igg Antibody ◽  
Compensatory Response ◽  
High Affinity ◽  
Pathogenic Factors

Abstract Autoantibodies to ADAMTS13 are well known to play an important role in the development of microthrombosis and organ ischaemia in thrombotic thrombocytopenic purpura (TTP). Antiphospholipid syndrome (APS) is an autoimmune disorder associated with thrombosis and pregnancy failure, but in severe cases of APS, microvascular thrombosis can occur similar to that seen in TTP - suggesting possible mutual pathogenic factors. The role of ADAMTS13 in APS patients is unknown and we hypothesize that ADAMTS13 may play a role in the development of thrombosis in the APS population. We evaluated ADAMTS13 in 68 patients: 52 with APS (as defined by the revised Sapporo Criteria), and 16 with anti-phospholipid antibodies (aPL) only. Of the 68 patients, 38 (56%) had IgG antibody to ADAMTS13 (median 13.2 ug/ml, range 9.8 – 28.3 ug/ml, NR< 9.6 ug/ml) by ELISA (Imubind ELISA, American Diagnostica Inc). 25/68 patients (37%) demonstrated low ADAMTS13 activity by our in-house collagen binding assay (median 33.2%, range 0–64%, NR 66–126%), with 12 of the 25 patients demonstrating detectable antibody to ADAMTS13. Low activity was not associated with elevated VWF:Ag levels suggesting that high VWF turnover did not account for the low ADAMTS Activity. In addition, ADAMTS13 Antigen levels (Imubind ELISA, American Diagnostica Inc) were elevated in 45/68 (66%) (median 850 ng/ml, range 890–1379 ng/ml, NR350-730ng/ml) indicating discordance with the observed low ADAMTS13 activity levels. The increased ADAMTS13 antigen may reflect a compensatory response to the presence of autoantibodies to ADAMTS13 in APS. The abnormal ADAMTS13 findings were not associated with the presence of anticardiolipin antibody, anti-β2glycoprotein1 or lupus anticoagulant. Similarly, no association was seen in analysis of clinical subgroups (arterial or venous thrombosis, recurrent miscarriage). We subsequently purified IgG from plasma of 3 of the APS patients with detectable anti-ADAMTS13 autoantibody and observed strong binding to ADAMTS13 via ELISA. Furthermore using the purified IgG, increasing NaCl concentrations did not prevent antibody binding to ADAMTS suggesting that these antibodies are high affinity. These findings suggest that ADAMTS13 autoantibodies may have a role in other autoimmune thrombotic conditions aside from TTP. In APS, the prevalence of these high affinity antibodies may well be a pathogenic feature integral to shifting the haemostatic balance in favour of thrombosis.

Obstetric antiphospholipid syndrome: current uncertainties should guide our way

Lupus ◽  
2010 ◽  
Vol 19 (4) ◽  
pp. 446-452 ◽  
Author(s):  
DW Branch ◽  
RM Silver ◽  
TF Porter
Keyword(s):  
Antiphospholipid Syndrome ◽  
Reproductive Medicine ◽  
Fetal Death ◽  
Recurrent Miscarriage ◽  
Antiphospholipid Antibody ◽  
The Us ◽  
The World ◽  
Obstetric Antiphospholipid Syndrome ◽  
The Subject ◽  
The Common

The subject of obstetric antiphospholipid syndrome (APS) has been reviewed dozens of times, and there is little doubt that the international APS community has done well in bringing APS to the attention of clinicians around the world. However, the evolution of clinical practice, at least in the US, also has convinced us that our field would benefit from further clinical study. For example, the number of women diagnosed with ‘APS’, but who do not meet the revised Sapporo criteria, seems to have increased. It is now common practice for women with recurrent miscarriage or prior fetal death to be treated with heparin, even in the presence of indeterminate or low titer antiphospholipid antibody (aPL) levels and even after only one positive test. In part, this common practice derives from confusion on the part of many clinicians and patients regarding the diagnosis of APS as well as the clinical and laboratory criteria for the syndrome. In part, this derives from the common practice of so-called ‘empiric treatment’ in US reproductive medicine, often driven as much by patients as by clinicians. This brief commentary focuses on areas of uncertainty that we see as deserving of new or renewed study for the sake of improving our understanding of APS and best patient care.

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