Antiphospholipid syndrome (APS) covers a spectrum of clinical manifestations ranging from recurrent pregnancy loss and obstetric complications from placental dysfunction through to thrombotic disease. This article will focus on the common manifestations of the pregnancy-related complications of APS. This includes clinical manifestations, diagnosis and management, as general practitioners will need to be able to recognize the disorder and will also have patients under their care receiving treatment for APS.
HughesGR. Thrombosis, abortion, cerebral disease, and the lupus anticoagulant. Br Med J (Clin Res Ed)1983; 287: 1088–1089.
2.
SchreiberKRadinMSciasciaS. Current insights in obstetric antiphospholipid syndrome. Curr Opin Obstet Gynecol2017; 6: 397–403.
3.
Mehrani T, Petri M. In: Cervera R, Reverter JC, Khamashta M (eds) Handbook of systemic autoimmune diseases. Vol. 10. Amsterdam: Elsevier, 2009.
4.
Regan L, Backos M, Rai R for the Royal College of Obstetricians and Gynaecologists. The investigation and treatment of couples with recurrent first-trimester and recurrent second-trimester miscarriage. Green-top guideline number 17. (April 2011) https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_17.pdf (accessed 5 October 2018).
MiyakisSLockshinMDAtsumiTet al.International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost2006; 4: 295–306.
7.
RolnikDLWrightDPoonLCet al.Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. N Engl J Med2017; 377: 613–622.
8.
Nelson-Piercy C, MacCallum P, Mackillop L for the Royal College of Obstetricians and Gynaecologists. Reducing the risk of venous thromboembolism during pregnancy and the puerperium. Green-top guideline number 37a. (April 2015). https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-37a.pdf (accessed 5 October 2018).
9.
EmpsonMLassereMCraigJScottJ. Prevention of recurrent miscarriage for women with antiphospholipid antibody or lupus anticoagulant. Cochrane Database Syst Rev2005, pp. CD002859–CD002859.
10.
KeelingDMackieIMooreGWet al.Guidelines on the investigation and management of antiphospholipid syndrome. Br J Haematol2012; 157: 47–58.
11.
Ofer-ShiberSMoladY. Frequency of vascular and pregnancy morbidity in patients with low vs. moderate-to-high titers of antiphospholipid antibodies. Blood Coagul Fibrinolysis2015; 26: 261–266.
12.
CohenHHuntBJEfthymiouMet al.Rivaroxaban versus warfarin to treat patients with thrombotic antiphospholipid syndrome, with or without systemic lupus erythematosus (RAPS): A randomised, controlled, open-label, phase 2/3, non-inferiority trial. Lancet Haematol2016; 3: e426–e436.
13.
MyersBNealRMyersORupareliaM. Unplanned pregnancy on a direct oral anticoagulant (Rivaroxaban): A warning. Obstet Med2016; 9: 40–42.
14.
CohenHArachchillageDRMiddeldorpSBeyer-WesendorfJAbdul-KadirR. Management of direct oral anticoagulants in women of childbearing potential: Guidance from the SSC of the ISTH. J Thromb Haemost2016; 14: 1673–1676.
15.
SchreiberKBreenKCohenHet al.HYdroxychloroquine to improve pregnancy outcome in women with AnTIphospholipid Antibodies (HYPATIA) protocol: A multinational randomized controlled trial of hydroxychloroquine versus placebo in addition to standard treatment in pregnant women with antiphospholipid syndrome or antibodies. Semin Thromb Hemost2017; 43: 562–571.
