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Upgrading Therapy Strategy Improves Pregnancy Outcome in Antiphospholipid Syndrome: A Cohort Management Study.
Thromb Haemost 2020; 120(1):36-43TH

Abstract

The current study evaluates the efficacy and safety of different treatment strategies for pregnant patients with antiphospholipid syndrome. One hundred twenty-seven consecutive pregnancies were assessed; 87 (68.5%) with a history of pregnancy morbidity alone were treated with prophylactic low molecular weight heparin (LMWH) + low-dose aspirin (LDA, 100 mg) (group I) and 40 (31.5%) with a history of thrombosis and/or severe pregnancy complications with therapeutic LMWH + LDA (group II). LMWH doses were increased throughout the pregnancies depending on the patients' weight gain, and treatment was switched to a more intensive one at the first sign of maternal/fetal complications. The study's primary outcome was live births. There were no significant differences in live birth rate between group I (95.4%) and group II (87.5%). Even fetal complication rate was similar in the two groups; group II nevertheless had a higher prevalence of maternal and neonatal complications (p = 0.0005 and p = 0.01, respectively) and registered a significantly lower gestational age at delivery and birth weight (p = 0.0001 and p = 0.0005, respectively). Two patients in group I switched to group II therapy, six patients in group II switched to a more intensive treatment strategy (weekly plasma exchange + fortnightly intravenous immunoglobulins in addition to therapeutic LMWH + LDA). The multivariate analysis uncovered that triple antiphospholipid antibodies positivity was an independent factor leading to a more intensive therapy. All eight switched patients achieved a live birth. Study results revealed that adjusted LMWH doses and switching therapy at first signs of severe pregnancy complications led to a high rate of live births in antiphospholipid syndrome patients.

Authors+Show Affiliations

Department of Medicine-DIMED, Rheumatology Unit, University of Padua, Padua, Italy. Department of Medicine, Internal Medicine Unit, San Bortolo Hospital, Vicenza, Italy.Department of Medicine-DIMED, Rheumatology Unit, University of Padua, Padua, Italy.Department of Medicine-DIMED, Rheumatology Unit, University of Padua, Padua, Italy.Department of Medicine-DIMED, Rheumatology Unit, University of Padua, Padua, Italy.Obstetrics and Gynaecology Unit, University Hospital Padua, Padua, Italy.Obstetrics and Gynaecology Unit, University Hospital Padua, Padua, Italy.Department of Medicine-DIMED, Rheumatology Unit, University of Padua, Padua, Italy.Department of Medicine-DIMED, Rheumatology Unit, University of Padua, Padua, Italy.Department of Medicine-DIMED, Rheumatology Unit, University of Padua, Padua, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31634958

Citation

Hoxha, Ariela, et al. "Upgrading Therapy Strategy Improves Pregnancy Outcome in Antiphospholipid Syndrome: a Cohort Management Study." Thrombosis and Haemostasis, vol. 120, no. 1, 2020, pp. 36-43.
Hoxha A, Favaro M, Calligaro A, et al. Upgrading Therapy Strategy Improves Pregnancy Outcome in Antiphospholipid Syndrome: A Cohort Management Study. Thromb Haemost. 2020;120(1):36-43.
Hoxha, A., Favaro, M., Calligaro, A., Del Ross, T., Ruffatti, A. T., Infantolino, C., ... Ruffatti, A. (2020). Upgrading Therapy Strategy Improves Pregnancy Outcome in Antiphospholipid Syndrome: A Cohort Management Study. Thrombosis and Haemostasis, 120(1), pp. 36-43. doi:10.1055/s-0039-1697665.
Hoxha A, et al. Upgrading Therapy Strategy Improves Pregnancy Outcome in Antiphospholipid Syndrome: a Cohort Management Study. Thromb Haemost. 2020;120(1):36-43. PubMed PMID: 31634958.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Upgrading Therapy Strategy Improves Pregnancy Outcome in Antiphospholipid Syndrome: A Cohort Management Study. AU - Hoxha,Ariela, AU - Favaro,Maria, AU - Calligaro,Antonia, AU - Del Ross,Teresa, AU - Ruffatti,Alessandra Teresa, AU - Infantolino,Chiara, AU - Tonello,Marta, AU - Mattia,Elena, AU - Ruffatti,Amelia, Y1 - 2019/10/21/ PY - 2019/10/22/pubmed PY - 2019/10/22/medline PY - 2019/10/22/entrez SP - 36 EP - 43 JF - Thrombosis and haemostasis JO - Thromb. Haemost. VL - 120 IS - 1 N2 - The current study evaluates the efficacy and safety of different treatment strategies for pregnant patients with antiphospholipid syndrome. One hundred twenty-seven consecutive pregnancies were assessed; 87 (68.5%) with a history of pregnancy morbidity alone were treated with prophylactic low molecular weight heparin (LMWH) + low-dose aspirin (LDA, 100 mg) (group I) and 40 (31.5%) with a history of thrombosis and/or severe pregnancy complications with therapeutic LMWH + LDA (group II). LMWH doses were increased throughout the pregnancies depending on the patients' weight gain, and treatment was switched to a more intensive one at the first sign of maternal/fetal complications. The study's primary outcome was live births. There were no significant differences in live birth rate between group I (95.4%) and group II (87.5%). Even fetal complication rate was similar in the two groups; group II nevertheless had a higher prevalence of maternal and neonatal complications (p = 0.0005 and p = 0.01, respectively) and registered a significantly lower gestational age at delivery and birth weight (p = 0.0001 and p = 0.0005, respectively). Two patients in group I switched to group II therapy, six patients in group II switched to a more intensive treatment strategy (weekly plasma exchange + fortnightly intravenous immunoglobulins in addition to therapeutic LMWH + LDA). The multivariate analysis uncovered that triple antiphospholipid antibodies positivity was an independent factor leading to a more intensive therapy. All eight switched patients achieved a live birth. Study results revealed that adjusted LMWH doses and switching therapy at first signs of severe pregnancy complications led to a high rate of live births in antiphospholipid syndrome patients. SN - 2567-689X UR - https://www.unboundmedicine.com/medline/citation/31634958/Upgrading_Therapy_Strategy_Improves_Pregnancy_Outcome_in_Antiphospholipid_Syndrome:_A_Cohort_Management_Study L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-0039-1697665 DB - PRIME DP - Unbound Medicine ER -