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Management of the obstetric antiphospholipid syndrome

  1. Ronald H. W. M. Derksen1,*,
  2. Munther A. Khamashta2,
  3. D. Ware Branch3

Article first published online: 5 APR 2004

DOI: 10.1002/art.20105

Issue

Arthritis & Rheumatism

Arthritis & Rheumatism

Volume 50, Issue 4, pages 1028–1039, April 2004

Additional Information

How to Cite

Derksen, R. H. W. M., Khamashta, M. A. and Branch, D. W. (2004), Management of the obstetric antiphospholipid syndrome. Arthritis & Rheumatism, 50: 1028–1039. doi: 10.1002/art.20105

Author Information

  1. 1

    University Medical Center, Utrecht, The Netherlands

  2. 2

    Lupus Research Unit, Rayne Institute, St. Thomas' Hospital, London, UK

  3. 3

    University of Utah Health Sciences Center, Salt Lake City

*Department of Rheumatology and Clinical Immunology (F02.127), University Medical Center, PO Box 85500, Utrecht 3508GA, The Netherlands

Publication History

  1. Issue published online: 5 APR 2004
  2. Article first published online: 5 APR 2004
  3. Manuscript Accepted: 3 DEC 2003
  4. Manuscript Received: 18 JUN 2003

Funded by

  • Lupus UK
  • St. Thomas' Lupus Trust
  • H. A. and Edna Benning Presidential Endowed Chair at the University of Utah

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REFERENCES

  • 1
    Levine JS, Branch DW, Rauch J. The antiphospholipid syndrome. N Engl J Med 2002; 346: 752–63.
  • 2
    Mueh JR, Herbst KD, Rapaport SI. Thrombosis in patients with the lupus anticoagulant. Ann Intern Med 1980; 92: 156–9.
  • 3
    Derue G, Englert HJ, Harris EN, Gharavi A, Morgan SH, Hull RG, et al. Fetal loss in systemic lupus: association with anticardiolipin antibodies. J Obstet Gynaecol 1985; 5: 207–9.
  • 4
    Boey ML, Colaco CB, Gharavi AE, Elkon KB, Loizou S, Hughes GR. Thrombosis in systemic lupus erythematosus: striking association with the presence of circulating lupus anticoagulant. Br Med J 1983; 287: 1021–3.
  • 5
    Harris EN, Gharavi AE, Hughes GR. Anti-phospholipid antibodies. Clin Rheum Dis 1985; 11: 591–609.
  • 6
    Asherson RA, Khamashta MA, Ordi-Ros J, Derksen RH, Machin SJ, Barquinero J, et al. The “primary” antiphospholipid syndrome: major clinical and serological features. Medicine (Baltimore) 1989; 68: 366–74.
  • 7
    Harris EN. Syndrome of the black swan. Br J Rheumatol 1987; 26: 324–6.
  • 8
    HarrisEN, ExnerT, HughesGR, AshersonRA, editors. Phospholipid-binding antibodies. Boca Raton: CRC Press; 1991. p. 373–6.
  • 9
    Khamashta MA, Hughes GR. ACP Broadsheet no 136: February 1993. Detection and importance of anticardiolipin antibodies. J Clin Pathol 1993; 46: 104–7.
  • 10
    Branch DW, Silver RM. Criteria for antiphospholipid syndrome: early pregnancy loss, fetal loss, or recurrent pregnancy loss? Lupus 1996; 5: 409–13.
  • 11
    Goldstein SR. Embryonic death in early pregnancy: a new look at the first trimester. Obstet Gynecol 1994; 84: 294–7.
  • 12
    Tulppala M, Marttunen M, Soderstrom-Anttila V, Foudila T, Ailus K, Palosuo T, et al. Low-dose aspirin in prevention of miscarriage in women with unexplained or autoimmune related recurrent miscarriage: effect on prostacyclin and thromboxane A2 production. Hum Reprod 1997; 12: 1567–72.
  • 13
    Van Leeuwen I, Branch DW, Scott JR. First-trimester ultrasonography findings in women with a history of recurrent pregnancy loss. Am J Obstet Gynecol 1993; 168: 111–4.
  • 14
    Wilson WA, Gharavi AE, Koike T, Lockshin MD, Branch DW, Piette JC, et al. International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome: report of an international workshop. Arthritis Rheum 1999; 42: 1309–11.
    Direct Link:
  • 15
    Feinstein DI, Rapaport SI. Acquired inhibitors of blood coagulation. Prog Hemost Thromb 1972; 1: 75–95.
  • 16
    Exner T, Triplett DA, Taberner D, Machin SJ, and the SSC Subcommittee for the Standardization of Lupus Anticoagulants. Guidelines for testing and revised criteria for lupus anticoagulants. Thromb Haemost 1991; 65: 320–2.
  • 17
    Brandt JT, Barna LK, Triplett DA, and the Subcommittee on Lupus Anticoagulants/Antiphospholipid Antibodies of the ISTH. Laboratory identification of lupus anticoagulants: results of the Second International Workshop for Identification of Lupus Anticoagulants. Thromb Haemost 1995; 74: 1597–603.
  • 18
    Harris EN. Special report: the Second International Anti-cardiolipin Standardization Workshop/the Kingston Anti-Phospholipid Antibody Study (KAPS) group. Am J Clin Pathol 1990; 94: 476–84.
  • 19
    Harris EN, Pierangeli S, Birch D. Anticardiolipin wet workshop report: Fifth International Symposium on Antiphospholipid Antibodies. Am J Clin Pathol 1994; 101: 616–24.
  • 20
    Pierangeli SS, Stewart M, Silva LK, Harris EN. An antiphospholipid wet workshop: 7th International Symposium on Antiphospholipid Antibodies. J Rheumatol 1998; 25: 156–60.
  • 21
    Reber G, Arvieux J, Comby E, Degenne D, de Moerloose P, Sanmarco M, et al, and The Working Group on Methodologies in Haemostasis from the GEHT (Groupe d'Etudes sur l'Hemostase et la Thrombose). Multicenter evaluation of nine commercial kits for the quantitation of anticardiolipin antibodies. Thromb Haemost 1995; 73: 444–52.
  • 22
    Coulam CB, McIntyre JA, Wagenknecht D, Rote N. Interlaboratory inconsistencies in detection of anticardiolipin antibodies [letter]. Lancet 1990; 335: 865.
  • 23
    Peaceman AM, Silver RK, MacGregor SN, Socol ML. Interlaboratory variation in antiphospholipid antibody testing. Am J Obstet Gynecol 1992; 166: 1780–4.
  • 24
    Favaloro EJ, Silvestrini R, Mohammed A. Clinical utility of anticardiolipin antibody assays: high inter-laboratory variation and limited consensus by participants of external quality assurance programs signals a cautious approach. Pathology 1999; 31: 142–7.
  • 25
    Tincani A, Allegri F, Sanmarco M, Cinquini M, Taglietti M, Balestrieri G, et al. Anticardiolipin antibody assay: a methodological analysis for a better consensus in routine determinations—a cooperative project of the European Antiphospholipid Forum. Thromb Haemost 2001; 86: 575–83.
  • 26
    Silver RM, Porter TF, van Leeuween I, Jeng G, Scott JR, Branch DW. Anticardiolipin antibodies: clinical consequences of “low titers”. Obstet Gynecol 1996; 87: 494–500.
  • 27
    Infante-Rivard C, David M, Gauthier R, Rivard GE. Lupus anticoagulants, anticardiolipin antibodies, and fetal loss: a case-control study. N Engl J Med 1991; 325: 1063–6.
  • 28
    Pattison NS, Chamley LW, McKay EJ, Liggins GC, Butler WS. Antiphospholipid antibodies in pregnancy: prevalence and clinical associations. Br J Obstet Gynaecol 1993; 100: 909–13.
  • 29
    Laskin CA, Bombardier C, Hannah ME, Mandel FP, Ritchie JW, Farewell V, et al. Prednisone and aspirin in women with autoantibodies and unexplained recurrent fetal loss. N Engl J Med 1997; 337: 148–53.
  • 30
    Rai R, Cohen H, Dave M, Regan L. Randomised controlled trial of aspirin and aspirin plus heparin in pregnant women with recurrent miscarriage associated with phospholipid antibodies (or antiphospholipid antibodies). BMJ 1997; 314: 253–7.
  • 31
    Farquharson RG, Quenby S, Greaves M. Antiphospholipid syndrome in pregnancy: a randomized, controlled trial of treatment. Obstet Gynecol 2002; 100: 408–13.
  • 32
    Pattison NS, Chamley LW, Birdsall M, Zanderigo AM, Liddell HS, McDougall J. Does aspirin have a role in improving pregnancy outcome for women with the antiphospholipid syndrome? A randomized controlled trial. Am J Obstet Gynecol 2000; 183: 1008–12.
  • 33
    Lockshin MD, Sammaritano L. Antiphospholipid antibodies and fetal loss. N Engl J Med 1992; 326: 951–2.
  • 34
    Kilpatrick DC. Antiphospholipid antibodies in pregnancy: prevalence and clinical associations [letter]. Br J Obstet Gynaecol 1994; 101: 739.
  • 35
    Kingdom J, Jauniaux E. Treatment of pregnant women with recurrent miscarriage associated with antiphospholipid antibodies [letter]. BMJ 1997; 315: 372.
  • 36
    Silver RM, Branch DW, Scott JR. Prednisone and aspirin in women with recurrent fetal loss [letter]. N Engl J Med 1997; 337: 1629.
  • 37
    Rai R, Regan L. Antiphospholipid syndrome in pregnancy: a randomized, controlled trial of treatment [letter]. Obstet Gynecol 2002; 100: 1354.
  • 38
    Kutteh WH. Antiphospholipid syndrome in pregnancy [letter]. Obstet Gynecol 2002; 100: 1354.
  • 39
    Ruiz-Irastorza G, Nelson-Piercy C, Khamashta MA. Aspirin to treat obstetric manifestations of the antiphospholipid syndrome. Am J Obstet Gynecol 2001; 185: 523–4.
  • 40
    Lynch A, Marlar R, Murphy J, Davila G, Santos M, Rutledge J, et al. Antiphospholipid antibodies in predicting adverse pregnancy outcome: a prospective study. Ann Intern Med 1994; 120: 470–5.
  • 41
    Lockwood CJ, Romero R, Feinberg RF, Clyne LP, Coster B, Hobbins JC. The prevalence and biologic significance of lupus anticoagulant and anticardiolipin antibodies in a general obstetric population. Am J Obstet Gynecol 1989; 161: 369–73.
  • 42
    Yasuda M, Takakuwa K, Tokunaga A, Tanaka K. Prospective studies of the association between anticardiolipin antibody and outcome of pregnancy. Obstet Gynecol 1995; 86: 555–9.
  • 43
    Cowchock S, Reece EA, and the Organizing Group of the Antiphospholipid Antibody Treatment Trial. Do low-risk pregnant women with antiphospholipid antibodies need to be treated? Am J Obstet Gynecol 1997; 176: 1099–100.
  • 44
    Balasch J, Carmona F, Lopez-Soto A, Font J, Creus M, Fabregues F, et al. Low-dose aspirin for prevention of pregnancy losses in women with primary antiphospholipid syndrome. Hum Reprod 1993; 8: 2234–9.
  • 45
    Backos M, Rai R, Baxter N, Chilcott IT, Cohen H, Regan L. Pregnancy complications in women with recurrent miscarriage associated with antiphospholipid antibodies treated with low dose aspirin and heparin. Br J Obstet Gynaecol 1999; 106: 102–7.
  • 46
    Rai RS, Clifford K, Cohen H, Regan L. High prospective fetal loss rate in untreated pregnancies of women with recurrent miscarriage and antiphospholipid antibodies. Hum Reprod 1995; 10: 3301–4.
  • 47
    Kutteh WH. Antiphospholipid antibody-associated recurrent pregnancy loss: treatment with heparin and low-dose aspirin is superior to low-dose aspirin alone. Am J Obstet Gynecol 1996; 174: 1584–9.
  • 48
    Cowchock FS, Reece EA, Balaban D, Branch DW, Plouffe L. Repeated fetal losses associated with antiphospholipid antibodies: a collaborative randomized trial comparing prednisone with low-dose heparin treatment. Am J Obstet Gynecol 1992; 166: 1318–23.
  • 49
    Silver RK, MacGregor SN, Sholl JS, Hobart JM, Neerhof MG, Ragin A. Comparative trial of prednisone plus aspirin versus aspirin alone in the treatment of anticardiolipin antibody-positive obstetric patients. Am J Obstet Gynecol 1993; 169: 1411–7.
  • 50
    Kutteh WH, Ermel LD. A clinical trial for the treatment of antiphospholipid antibody-associated recurrent pregnancy loss with lower dose heparin and aspirin. Am J Reprod Immunol 1996; 35: 402–7.
  • 51
    Lockshin MD, Druzin ML, Qamar T. Prednisone does not prevent recurrent fetal death in women with antiphospholipid antibody. Am J Obstet Gynecol 1989; 160: 439–43.
  • 52
    Branch DW, Silver RM, Blackwell JL, Reading JC, Scott JR. Outcome of treated pregnancies in women with antiphospholipid syndrome: an update of the Utah experience. Obstet Gynecol 1992; 80: 614–20.
  • 53
    Lima F, Khamashta MA, Buchanan NM, Kerslake S, Hunt BJ, Hughes GR. A study of sixty pregnancies in patients with the antiphospholipid syndrome. Clin Exp Rheumatol 1996; 14: 131–6.
  • 54
    Rosove MH, Tabsh K, Wasserstrum N, Howard P, Hahn BH, Kalunian KC. Heparin therapy for pregnant women with lupus anticoagulant or anticardiolipin antibodies. Obstet Gynecol 1990; 75: 630–4.
  • 55
    Branch DW, Peaceman AM, Druzin M, Silver RK, El Sayed Y, Silver RM, et al, and the Pregnancy Loss Study Group. A multicenter, placebo-controlled pilot study of intravenous immune globulin treatment of antiphospholipid syndrome during pregnancy. Am J Obstet Gynecol 2000; 182: 122–7.
  • 56
    Stirrat GM. Recurrent miscarriage. Lancet 1990; 336: 673–5.
  • 57
    Liddell HS, Pattison NS, Zanderigo A. Recurrent miscarriage: outcome after supportive care in early pregnancy. Aust N Z J Obstet Gynaecol 1991; 31: 320–2.
    Direct Link:
  • 58
    Stray-Pedersen B, Stray-Pedersen S. Etiologic factors and subsequent reproductive performance in 195 couples with a prior history of habitual abortion. Am J Obstet Gynecol 1984; 148: 140–6.
  • 59
    Clifford K, Rai R, Regan L. Future pregnancy outcome in unexplained recurrent first trimester miscarriage. Hum Reprod 1997; 12: 387–9.
  • 60
    Empson M, Lassere M, Craig JC, Scott JR. Recurrent pregnancy loss with antiphospholipid antibody: a systematic review of therapeutic trials. Obstet Gynecol 2002; 99: 135–44.
  • 61
    Derksen RH, de Groot PG, Kappelle LJ. Low dose aspirin after ischemic stroke associated with antiphospholipid syndrome. Neurology 2003; 61: 111–4.
  • 62
    Ginsberg JS, Greer I, Hirsh J. Use of antithrombotic agents during pregnancy. Chest 2001; 119(1 Suppl ): 122S–31S.
  • 63
    Pauzner R, Dulitzki M, Langevitz P, Livneh A, Kenett R, Many A. Low molecular weight heparin and warfarin in the treatment of patients with antiphospholipid syndrome during pregnancy. Thromb Haemost 2001; 86: 1379–84.
  • 64
    Sanson BJ, Lensing AW, Prins MH, Ginsberg JS, Barkagan ZS, Lavenne-Pardonge E, et al. Safety of low-molecular-weight heparin in pregnancy: a systematic review. Thromb Haemost 1999; 81: 668–72.
  • 65
    Out HJ, Derksen RH, Christiaens GC. Systemic lupus erythematosus and pregnancy. Obstet Gynecol Surv 1989; 44: 585–91.
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