Diagnostic and therapeutic approach to pregnant women suspect on antiphospholipid syndrome

Antifosfolipidni sindrom predstavlja pojavu antifosfolipidnih antitijela, vaskularne tromboze i pojavu problema s reprodukcijom žene. Cilj rada bio je prikazati naša iskustva u dijagnostici i liječenju ovog sindroma. U studiju je uključeno 62 bolesnica, 32 s primarnim (PAPS) i 30 sa sekundarnim antifosfolipidnim sindromom (SAPS). 36 bolesnica bilo je trudno, te prospektivno praćeno kroz trudnoću i šest postpartalnih tjedana. 23 bolesnice (71,9%) je bilo lupus-antikoagulant (LA) pozitivno u PAPS-u, a svega 10 (33,3%) u SAPS-u. Antikardioplipin (aCL) je imao češću pojavu u SAPS-u 8 (26,6%) u odnosu na PAPS 3 (9,4%). U tri bolesnice (3,3%) PAPS-u je dijagnosticiran pozitivnošću na antibeta2glikoprotein1 (antiβ2GP1). Najčešća manifestacija u prijašnjim trudnoćama bila je spontani abortus: 25 bolesnica (69,4%), preeklampsija 7 bolesnica (19,4%) koja je u tri bolesnice bila praćena unutarmaterničnim zastojem rasta (IUGR). U četiri bolesnice radilo se o intrauterinoj smrti fetusa (11,1%). Prosječna duljina trajanja trudnoće iznosila je 37,06±0,7 tjedana. Uspješnost terapije aspirinom i niskomolekularnim heparinom je bila 97,2%.Antiphospholipid syndrome includes the presence of antiphospholipid antibodies, vascular thrombosis and reproductive function disturbances. The aim was to show our diagnostic and therapeutic experiences. 62 women were included in study, 32 with primary antiphospholipd syndrome (PAPS), and 30 with secondary antiphospholipid syndrome (SAPS). 36 were pregnant and studied prospectively throughout pregnancy and six weeks after the delivery. Lupus-anticoagulant (LA) was positive in 23 patients with PAPS (71.9%), and in 10 patients with SAPS (33.3%). In SAPS group anticardiolipin antibodies (aCL) was positive in 8 patients (26.6%) compared to PAPS group with 3 aCL positive patients (9.4%). Antibeta2glycoprotein1 (antiβ2GP1) was positive in 3 patients with PAPS. Complications in previous pregnancies were in 25 cases (69.4%) spontaneous abortion, in 7 cases (19.4%) preeclampsia with intrauterine growth restriction (IUGR) in 3 patients. In 4 cases the complication was fetal death in utero. Average pregnancy lasted 37,06±0,707 weeks. Therapy with low dose aspirin and low-molecular-weight heparin was successful in 97.2%

Antibody Profile of Pregnant Women with Antiphospholipid Syndrome and Pregnancy Outcome After Treatment with Low Dose Aspirin and Low-Weight-Molecular Heparin

The aim of the research was to show our diagnostic and therapeutic experience with antiphospholipid syndrome (APS) in pregnant women. 36 pregnant women suspect on APS were included in the study: 32 with primary antiphospholipd syndrome (PAPS) and 4 with secondary antiphospholipid syndrome (SAPS). All pregnant women received low-molecular-weight-heparin (LMWH) and low dose aspirin (LDA) therapy. Control group represented 26 women with SAPS and previous bad reproductive anamnesis. Average pregnancy lasted 37.060.707 weeks. LMWH and LDA therapy was successful in 97.22%. Lupus anticoagulant (LA) was found to be more frequent in PAPS group (71,87%). Anticardiolipin antibodies (aCL) were found to be more frequent in SAPS (26,66%). For three patients (3.37%), PAPS was diagnosed due to a fact that they had positive antibeta2-glycoprotein1 (anti-GP1). To make APS diagnosis, it is of great importance to search for all antiphospholipid antibodies. LMWH and low dose of acetylsalicylic acid should be the first choice therapy

The Investigation of Hereditary and Acquired Thrombophilia risk Factors in the Development of Complications in Pregnancy in Croatian Women

OBJECTIVES: To investigate the genetic and acquired thrombophilic risk factors in pregnancy-associated complications and venous thromboembolism (VTE) and evaluate the association between particular thrombophilic risk factors and thromboembolic complications. METHODS: In this study, pregnant women with pregnancy complications and VTE (N = 101) were the study group, and the control group were women with normal pregnancy (N = 102). All women underwent testing for factor V Leiden mutation (FVL), mutation of the coagulation factors II (FII20210), methylenetetrahydrofolate reductase (MTHFR), plasminogen activator inhibitor-1, antithrombin III (ATIII), protein C (PC) and protein S, lupus anticoagulant (LAC) antibodies, anticardiolipin antibodies and anti-beta-2-glycoprotein-1. RESULTS: In this study group, mutations of the FVL was 15.8% (16/101), FII20210 5.9% (6/101) and the MTHFR at locus 677 was TT in 19.8% (20/101). Deficiency of ATIII and PC were rare: 3.0% and 1.0%, respectively. LAC were significantly higher in the study group than in the control group: 32.7% versus 3.9%; p < 0.0005. Pregnant women with VTE have been more frequent for FVL (41.7%; p < 0.005), PC deficiency (25.0%; p < 0.005) and LAC (33.3%; p < 0.005). Combination of FVL and MTHFR mutation was related to the risk of recurrent fetal death and habitual abortion. CONCLUSION: The inherited and the acquired thrombophilic risk factors were found to be up to 10 times more common in the study group than in the control group