Oral Presentation Society of Obstetric Medicine of Australia and New Zealand ASM 2015

Modern Management of the Antiphospholipid Syndrome in reproductive health (#42)

Beverley Hunt 1
  1. Guy's & St Thomas' NHS Foundation Trust, London, ., United Kingdom

Antiphospholipid syndrome (APS) is the combination of thrombotic events and/or obstetrical morbidity in patients tested persistently positive for antiphospholipid antibodies (aPL)[1].. Laboratory tests to identify aPL includes solid-phase immunoassays (ELISA) to detect anticardiolipin (aCL) and anti-β2 glycoprotein 1 (aβ2GPI) antibodies and functional assays for lupus anticoagulants (LAC). The presence of aPL as to be confirmed at least in two occasions more than12weeks apart[1].

Obstetric morbidity in APS is characterized by early complications, such as recurrent abortions before the 10th week of gestation, and/or  later complications, such as fetal death ≥10 weeks of gestation, and prematurity before 34 weeks of gestation in relation with placental insufficiency[1]. Placental insufficiency can result in intrauterine growth restriction (IUGR), preeclampsia, eclampsia, placental abruption, and haemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome.

The prevention of obstetric complications is based on the use of low-dose aspirin and/or subcutaneous injections of unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH)[2, 5-6]. Women with APS who have had a previous thrombotic event are currently treated with low-dose aspirin and heparin[2]. In our unit, overall rates of live birth in women with aPL have been previously reported to be as high as 79%[7]. 

However, current treatment does not prevent all maternal, fetal and neonatal complications of APS. Our group showed that the addition of first-trimester low-dose prednisolone to conventional treatment improved the rate of live births in refractory aPL -related first trimester pregnancy loss(es) [8]. We have also looked at hydroxycloroquine (HCQ), traditionally an antimalarial drug, has been widely used in the treatment of patients with SLE where has been associated with a prevention of flares and better survival. [9]. Retrospective data on the use of HCQ in aPL pregnancies will be presented and a new trial -HYPATIA will be discussed [10,11].

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  2. Ruiz-Irastorza G, Crowther M, Branch W, Khamashta MA. Antiphospholipid syndrome. Lancet. 2010; 376: 1498-509.
  3. Petri M. Epidemiology of the antiphospholipid antibody syndrome. J Autoimmun. 2000;15:145-51.
  4. Papadopolous E, Magder L, Petri M. Antiphospholipid antibodies and venous thrombosis (VT) in SLE. Arthritis Rheum 1999;42 Suppl 9:S369
  5. Farquharson RG, Quenby S, Greaves M. Antiphospholipid syndrome in pregnancy: a randomized, controlled trial of treatment. Obstet Gynecol. 2002; 100: 408-13.
  6. Rai R, Regan L. Antiphospholipid syndrome in pregnancy: a randomized, controlled trial of treatment. Obstet Gynecoly. 2002; 100: 1354.
  7. Bramham K, Hunt BJ, Germain S, Calatayud I, Khamashta M, Bewley S, Nelson-Piercy C. Pregnancy outcome in different clinical phenotypes of antiphospholipid syndrome. Lupus. 2010; 19: 58-64.
  8. Bramham K, Thomas M, Nelson-Piercy C, Khamashta M, Hunt BJ. First-trimester low-dose prednisolone in refractory antiphospholipid antibody-related pregnancy loss. Blood. 2011; 117: 6948-51
  9. Hunt BJ. A novel antiphospholipid antibody agent? Blood. 2010; 115: 2124-5.
  10. Sciascia, Hunt BJ, Talavera-Garcia E, Lilso G, Khamashta MA, Cuadrado MJ. Am J Obstet Gynaecol 2015 Sept 28; in press
  11. Sciascia S, Branch DW, Levy RA, Middeldorp, Pavord S, Roccatello D, Ruiz-Irastorza G, Tincani A, Khamshta M, Schreiber K, Hunt BJ. Thromb Haemost 2015; 115 in press