The relation between antiphospholipid syndrome-related pregnancy morbidity and non-gravid vascular thrombosis: A review of the literature and management strategies |
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Authors: | Doruk Erkan |
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Institution: | (1) Division of Rheumatology, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, 10021 New York, NY, USA |
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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. |
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