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Antiphospholipid in obstetric patient

Frank Bienaimé, Christophe Legendre, Fabiola Terzi, Guillaume Canaud
The antiphospholipid syndrome is a common autoimmune disease caused by pathogenic antiphospholipid antibodies, leading to recurrent thrombosis and/or obstetrical complications. Importantly for nephrologists, antiphospholipid antibodies are associated with various renal manifestations including large renal vessel thrombosis, renal artery stenosis, and a constellation of intrarenal lesions that has been termed antiphospholipid nephropathy. This last condition associates various degrees of acute thrombotic microangiopathy, proliferative and fibrotic lesions of the intrarenal vessels, and ischemic modifications of the renal parenchyma...
August 20, 2016: Kidney International
Eleftheria Lefkou, Apostolos Mamopoulos, Themistoklis Dagklis, Christos Vosnakis, David Rousso, Guillermina Girardi
BACKGROUND: Administration of conventional antithrombotic treatment (low-dose aspirin plus low-molecular weight heparin [LDA+LMWH]) for obstetric antiphospholipid syndrome (APS) does not prevent life-threatening placenta insufficiency-associated complications such as preeclampsia (PE) and intrauterine growth restriction (IUGR) in 20% of patients. Statins have been linked to improved pregnancy outcomes in mouse models of PE and APS, possibly due to their protective effects on endothelium...
August 1, 2016: Journal of Clinical Investigation
Anush Martirosyan, Martin Petrek, Amit Kishore, Gayane Manukyan
Antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by thrombosis and recurrent fetal loss, with the persistent presence of antiphospholipid antibodies (aPLs). aPLs exert their pathogenic effect via the overproduction of tissue factor and activation of complement and several cell types, including endothelial cells, platelets and notably monocytes. As a result, a hypercoagulable state develops leading to APS-associated obstetric complications and fetal loss. Despite being far from optimal, treatment of APS usually includes heparin and low dose aspirin...
August 2016: Experimental and Therapeutic Medicine
C M Yelnik, G Urbanski, E Drumez, V Sobanski, H Maillard, A Lanteri, S Morell-Dubois, C Caron, S Dubucquoi, D Launay, A Duhamel, E Hachulla, P Y Hatron, M Lambert
INTRODUCTION: The long-term risk of first thrombosis and benefit of prophylaxis in antiphospholipid antibody (aPL) carriers without history of thrombosis or obstetrical morbidity is poorly known. This study aimed to evaluate the long-term rate and risk factors associated with a first thrombosis in those patients. PATIENTS AND METHODS: After a prior study ended in December 2005 and was already published, we extended the follow-up period of our cohort of aPL carriers...
July 17, 2016: Lupus
Arsène Mekinian, Marie-Charlotte Bourrienne, Lionel Carbillon, Amélie Benbara, Abisror Noémie, Sylvie Chollet-Martin, Ahmed Tigaizin, Francois Montestruc, Olivier Fain, Pascale Nicaise-Roland
OBJECTIVES: To describe the prevalence of non-conventional APL in patients with obstetrical APS without conventional APL and the impact of treatment on pregnancy outcome. METHODS: Patients with clinical obstetrical criteria were tested for anti-phosphatidylethanolamine (aPE) IgG/M, anti-prothrombin/phosphatidylserine (anti-PS/PT) IgG/M, and anti-annexin V IgG. Pregnancy losses rates were compared between APS, non-conventional APS, and non-APL and in untreated pregnancies to treated ones for each group...
October 2016: Seminars in Arthritis and Rheumatism
M Khamashta, M Taraborelli, S Sciascia, A Tincani
Antiphospholipid syndrome (APS) is an autoimmune condition characterized by the occurrence of thrombosis (arterial and/or venous), often multiple, and/or pregnancy morbidity. Thrombosis is one of the major disease mechanisms, mainly caused by activating endothelial cells, monocytes, and platelets. At present, the management of APS patients with a history of thrombosis is based on long-term antithrombotic therapy, due to the high rate of recurrent thrombosis (29% per year without treatment). Obstetrical APS includes heterogeneous pregnancy complications whose pathogenesis has been increasingly elucidated in the past years...
February 2016: Best Practice & Research. Clinical Rheumatology
M Galli, G Finazzi, T Barbui
The Antiphospholipid Syndrome (APS) is defined by the association between antiphospholipid antibodies, i.e. anticardiolipin (aCL) and/or lupus anticoagulant (LA) antibodies, and one or more of the following clinical manifestations: arterial and venous thrombosis, recurrent abortions and thrombocytopenia (1). Among them, deep venous thromboses, pulmonary embolism and thrombosis of the cerebral arteries are the most frequent events, occurring in approximately 1/3 of the patients. Thrombosis of the placental vessels (2) is considered the cause of the obstetrical complications (recurrent spontaneous abortions, fetal deaths or fetal growth retardation) suffered by approximately 10% of the women with antiphospholipid antibodies (1), whereas a variable degree of thrombocytopenia is reported by about 20-25% of the patients (3)...
1996: Hematology (Amsterdam, Netherlands)
Jaume Alijotas-Reig, Raquel Ferrer-Oliveras, Enrique Esteve-Valverde, Amelia Ruffatti, Angela Tincani, Elmina Lefkou, Maria Tiziana Bertero, Gerard Espinosa, Emmanuel Coloma, Sara de Carolis, Patrizia Rovere-Querini, Valentina Canti, Elisa Picardo, Micaela Fredi, Arsene Mekinian
AIM: To analyse the prevalence and effects of inherited thrombophilic disorders (ITD) on maternal-foetal outcomes in cases of antiphospholipid antibody related to obstetric complications. METHODS: Women with obstetric complaints who tested positive for aPL and with inherited thrombophilia were prospectively and retrospectively included. RESULTS: ITD data were available in 208 of 338: 147 had obstetric antiphospholipid syndrome (OAPS) and 61 aPL-related obstetric morbidity (OMAPS)...
August 2016: American Journal of Reproductive Immunology: AJRI
Mirjana Bećarević, Svetlana Ignjatović
The latest classification criteria for the diagnosis of the antiphospholipid syndrome (APS, an autoimmune disease characterized by thromboses, miscarriages and presence of antiphospholipid antibodies (Abs)) emphasized that thrombotic manifestations of APS should be without any signs of an inflammatory process. However, atherosclerosis (a chronic inflammatory response to the accumulation of lipoproteins in the walls of arteries) and APS are characterized by some similar features. We evaluated whether proinflammatory proteins were associated with the features of the primary APS (PAPS)...
October 2016: Clinical Rheumatology
Philipp Scholz, Markus Auler, Bent Brachvogel, Thomas Benzing, Peter Mallman, Thomas Streichert, Andreas R Klatt
Anti-phospholipid syndrome (APS) is one of the main causes for recurrent miscarriages. The diagnosis of APS is based on the occurrence of clinical symptoms such as thrombotic events or obstetric complications as well as the detection of antiphospholipid antibodies directed against β2-glycoprotein I and cardiolipin, or a positive lupus anticoagulant assay. However, there is a subpopulation of patients with clinical symptoms of APS, but the lack of serological markers (seronegative APS). In addition, a large proportion of patients with unexplained recurrent miscarriages exist...
2016: Biochemia Medica: časopis Hrvatskoga Društva Medicinskih Biokemičara
Amelia Ruffatti, Ariela Hoxha, Maria Favaro, Marta Tonello, Anna Colpo, Umberto Cucchini, Alessandra Banzato, Vittorio Pengo
Most investigators currently advocate prophylactic-dose heparin plus low-dose aspirin as the preferred treatment of otherwise healthy women with obstetric antiphospholipid syndrome, whilst women with a history of vascular thrombosis alone or associated with pregnancy morbidity are usually treated with therapeutic heparin doses in association with low-dose aspirin in an attempt to prevent both thrombosis and pregnancy morbidity. However, the protocols outlined above fail in about 20 % of pregnant women with antiphospholipid syndrome...
June 25, 2016: Clinical Reviews in Allergy & Immunology
Dulce María Albertina Camarena Cabrera, Claudia Rodriguez-Jaimes, Sandra Acevedo-Gallegos, Juan Manuel Gallardo-Gaona, Berenice Velazquez-Torres, José Antonio Ramírez-Calvo
Antiphospholipid antibody syndrome is a non-inflammatory autoimmune disease characterized by recurrent thrombotic events and/or obstetric complications associated with the presence of circulating antiphospholipid antibodies (anticardiolipin antibodies, anti-β2 glycoprotein-i antibodies, and/or lupus anticoagulant. Antiphospholipid antibodies are a heterogeneous group of autoantibodies associated with recurrent miscarriage, stillbirth, fetal growth restriction and premature birth. The diversity of the features of the proposed placental antiphospholipid antibodies fingerprint suggests that several disease processes may occur in the placentae of women with antiphospholipid antibody syndrome in the form of immune responses: inflammatory events, complement activation, angiogenic imbalance and, less commonly, thrombosis and infarction...
June 9, 2016: Reumatología Clinica
Charis Pericleous, Isabel Ferreira, Orietta Borghi, Francesca Pregnolato, Thomas McDonnell, Acely Garza-Garcia, Paul Driscoll, Silvia Pierangeli, David Isenberg, Yiannis Ioannou, Ian Giles, Pier Luigi Meroni, Anisur Rahman
INTRODUCTION: Currently available clinical assays to detect antiphospholipid antibodies (aPL) test for IgG and IgM antibodies to cardiolipin (aCL) and β2-glycoprotein I (aβ2GPI). It has been suggested that testing for IgA aPL and for antibodies to Domain I (DI), which carries the key antigenic epitopes of β2GPI, could add value to these current tests. We performed an observational, multicenter cohort study to evaluate the utility of IgG, IgM and IgA assays to each of CL, β2GPI and DI in APS...
2016: PloS One
Dirk Roggenbuck, Maria Orietta Borghi, Valentina Somma, Thomas Büttner, Peter Schierack, Katja Hanack, Claudia Grossi, Caterina Bodio, Paolo Macor, Philipp von Landenberg, Francesco Boccellato, Michael Mahler, Pier Luigi Meroni
BACKGROUND: Antiphospholipid antibodies (aPL) can be detected in asymptomatic carriers and infectious patients. The aim was to investigate whether a novel line immunoassay (LIA) differentiates between antiphospholipid syndrome (APS) and asymptomatic aPL+ carriers or patients with infectious diseases (infectious diseases controls (IDC)). METHODS: Sixty-one patients with APS (56 primary, 22/56 with obstetric events only, and 5 secondary), 146 controls including 24 aPL+ asymptomatic carriers and 73 IDC were tested on a novel hydrophobic solid phase coated with cardiolipin (CL), phosphatic acid, phosphatidylcholine, phosphatidylethanolamine, phosphatidylglycerol, phosphatidylinositol, phosphatidylserine, beta2-glycoprotein I (β2GPI), prothrombin, and annexin V...
2016: Arthritis Research & Therapy
Maria Laura Bertolaccini, Gregorio Contento, Ross Lennen, Giovanni Sanna, Philip J Blower, Michelle Ma, Kavitha Sunassee, Guillermina Girardi
Placental ischemic disease and adverse pregnancy outcomes are frequently observed in patients with antiphospholipid syndrome (APS). Despite the administration of conventional antithrombotic treatment a significant number of women continue to experience adverse pregnancy outcomes, with uncertain prevention and management. Efforts to develop effective pharmacological strategies for refractory obstetric APS cases will be of significant clinical benefit for both mothers and fetuses. Although the antimalarial drug, hydroxychloroquine (HCQ) is increasingly used to treat pregnant women with APS, little is known about its efficacy and mechanism of action of HCQ...
May 6, 2016: Journal of Autoimmunity
G Guettrot-Imbert, N Morel, V Le Guern, G Plu-Bureau, C Frances, N Costedoat-Chalumeau
A causal link has long been described between estrogen and systemic lupus erythematosus activity. Contraceptive and pregnancy management is now common for lupus patients, but pregnancy continues to be associated with higher maternal and fetal mortality/morbidity in systemic lupus erythematosus patients than among the general population. Potential complications include lupus flares, obstetric complications (fetal loss, in utero growth retardation, premature birth) and neonatal lupus syndrome. Association with antiphospholipid antibodies or antiphospholipid syndrome increases the risk of obstetric complications...
April 26, 2016: Annales de Dermatologie et de Vénéréologie
Ahlam Al Marzooqi, Alessia Leone, Jamal Al Saleh, Munther Khamashta
Antiphospholipid syndrome (APS) is a prothrombotic disease characterized by thrombosis and pregnancy morbidity in the presence of antiphospholipid antibodies (apL). Management of thrombosis is based on long-term oral anticoagulation and patients with arterial events should be treated aggressively. Primary thrombo-prophylaxis is recommended in patients with systemic lupus erythromatosus (SLE) and obstetric APS. Obstetric APS care is based on high-risk management and treatment with aspirin and heparin. Possible future therapies include statins, hydroxychloroquine, rituximab, and new anticoagulant drugs...
September 2016: Expert Review of Clinical Immunology
Ning Tang, Ziyong Sun, Shiyu Yin
BACKGROUND: The objective of the work was to study the manifestations of antiphospholipid syndrome (APS) in the Chinese population, and evaluate the ability of lupus anticoagulant (LAC) assays to identify APS. METHODS: Consecutive patients with APS from 2012 to 2015 in our hospital were recruited, strictly following the Sydney revised Sapporo criteria for APS classification. Meanwhile, in the LAC-positive population, LAC normalized ratios obtained from diluted Russell viper venom time (DRVVT) and silica clotting time (SCT) assays were compared between patients with and without APS...
April 20, 2016: Clinical Chemistry and Laboratory Medicine: CCLM
Rosanna Satta, Paola Marongiu, Francesca Cottoni
Antiphospholipid syndrome is an immune-mediated acquired disorder characterized by vein and/or artery thromboses and obstetrical complications associated with the presence of antiphospholipid antibodies in the blood. aPL include anticardiolipin antibodies (aCL), antiβ2glycoproteinI (antiβ2GPI), and lupus anticoagulant (LAC). A primitive idiopathic form and a secondary form of APS are recognized. The latter, observed mostly in patients affected by systemic lupus erythmatosus (SLE), has been described in numerous other autoimmune diseases...
April 2016: Giornale Italiano di Dermatologia e Venereologia: Organo Ufficiale, Società Italiana di Dermatologia e Sifilografia
Shulan Zhang, Ziyan Wu, Si Chen, Jing Li, Xiaoting Wen, Liubing Li, Wen Zhang, Jiuliang Zhao, Fengchun Zhang, Yongzhe Li
In this study, we evaluated the clinical performance of anti-β2-glycoprotein 1 domain 1 antibodies (aβ2GP1-D1) in the diagnosis of antiphospholipid syndrome (APS). Sera from 229 subjects were tested, including 35 patients with primary APS, 51 patients with APS associated to other diseases, 30 patients with non-APS thrombosis, 32 patients with non-APS pregnancy-related morbidity, 42 patients with systemic lupus erythematosus, and 39 healthy controls (HC). Serum IgG aβ2GP1-D1, IgG/IgM anti-cardiolipin (aCL) and IgG/IgM aβ2GP1 were measured by a chemiluminescence assay...
2016: Scientific Reports
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