Pathogenesis, Diagnosis and Management of Obstetric Antiphospholipid Syndrome : A Comprehensive Review
Alijotas-Reig, Jaume (Universitat Autònoma de Barcelona. Departament de Medicina)
Esteve-Valverde, Enrique (Althaia Xarxa Assistencial (Manresa))
Anunciación-Llunell, Ariadna (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Marques-Soares, Joana (Hospital Universitari Vall d'Hebron)
Pardos-Gea, Josep (Hospital Universitari Vall d'Hebron)
Miró-Mur, Francesc (Hospital Universitari Vall d'Hebron. Institut de Recerca)

Data:	2022
Resum:	Antiphospholipid syndrome is an autoimmune disorder characterized by vascular thrombosis and/or pregnancy morbidity associated with persistent antiphospholipid antibody positivity. Cases fulfilling the Sydney criteria for obstetric morbidity with no previous thrombosis are known as obstetric antiphospholipid syndrome (OAPS). OAPS is the most identified cause of recurrent pregnancy loss and late-pregnancy morbidity related to placental injury. Cases with incomplete clinical or laboratory data are classified as obstetric morbidity APS (OMAPS) and non-criteria OAPS (NC-OAPS), respectively. Inflammatory and thrombotic mechanisms are involved in the pathophysiology of OAPS. Trophoblasts, endothelium, platelets and innate immune cells are key cellular players. Complement activation plays a crucial pathogenic role. Secondary placental thrombosis appears by clot formation in response to tissue factor activation. New risk assessment tools could improve the prediction of obstetric complication recurrences or thromboses. The standard-of-care treatment consists of low-dose aspirin and prophylactic low molecular weight heparin. In refractory cases, the addition of hydroxychloroquine, low-dose prednisone or IVIG improve pregnancy outcomes. Statins and eculizumab are currently being tested for treating selected OAPS women. Finally, we revisited recent insights and concerns about the pathophysiology, diagnosis and management of OAPS.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article de revisió ; recerca ; Versió publicada
Matèria:	Antiphospholipid antibody ; Non-criteria antiphospholipid antibodies ; Diagnosis ; Pathogenesis ; Management ; Obstetric antiphospholipid syndrome ; Review
Publicat a:	Journal of clinical medicine, Vol. 11 Núm. 3 (january 2022) , ISSN 2077-0383

DOI: 10.3390/jcm11030675
PMID: 35160128

26 p, 855.4 KB

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