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Review
. 2022 Jan 10;14(1):e21090.
doi: 10.7759/cureus.21090. eCollection 2022 Jan.

Obstetric Antiphospholipid Syndrome From the Perspective of a Rheumatologist

Juan Camilo Santacruz  1 , Marta Juliana Mantilla  1 , Igor Rueda  1 , Sandra Pulido  2 , Gustavo Rodríguez  1 , John Londono  1
Affiliations
Review

Obstetric Antiphospholipid Syndrome From the Perspective of a Rheumatologist

Juan Camilo Santacruz et al. Cureus. .

Abstract

Antiphospholipid syndrome (APS) is an autoimmune disease that can lead to thrombotic or obstetric complications. Recent histopathological studies have shown the absence of placental thrombosis, leading to the consideration of other pathophysiological pathways such as inflammation and complement activation. Due to this, various clinical studies are being carried out with different drug agents in order to avoid their complications. The combination of prophylactic heparin treatment and low doses of aspirin today result in successful pregnancies in most cases. Despite this, a minority of patients require alternative therapies to avoid recurrent miscarriage and decrease obstetric morbidity. Thanks to the better understanding of its pathophysiology, other treatments such as low doses of glucocorticoids, hydroxychloroquine (HCQ), immunoglobulin, pravastatin, and plasmapheresis have been considered in refractory cases, achieving favorable results. Despite the great advances regarding its treatment, unfortunately, there are no treatments with a good level of evidence to reduce late obstetric complications. The evaluation of preconception risk factors, as well as the antiphospholipid antibody profile, is necessary to establish individual risk and thus anticipate possible complications.

Keywords: antiphospholipid antibodies; hydroxychloroquine; obstetric antiphospholipid syndrome; placental insufficiency; thrombosis.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Synopsis of the pathophysiology of obstetric APS
ApoER2: apolipoprotein E receptor 2; LRP8: low-density lipoprotein receptor-related protein 8; IL: interleukin; NETs: extracellular neutrophil traps; STAT3: signal transducer and activator of transcription 3; sVEGFR1: soluble vascular endothelial growth factor receptor 1; TNF-ɑ: tumor necrosis factor-alpha References: [20-30]
Figure 2
Figure 2. Sequential algorithm for the treatment of obstetric APS and refractory obstetric APS
APS: antiphospholipid syndrome; HCQ: hydroxychloroquine; LDA; low-dose aspirin; LMWH: low-molecular-weight heparin; UFH; unfractionated heparin References: [44,48,50,53]
See this image and copyright information in PMC

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