Management of the controversial aspects of the antiphospholipid syndrome pregnancies: a guide for clinicians and researchers
1Division of Rheumatology, Hospital for Special Surgery, Weill Medical College of Cornell University, NY, USA, 2Rheumatology and Clinical Immunology Unit, University of Brescia, Brescia and 3Department of Infant Medicine, University of Milan, IRCCS Istituto Auxologico Italiano, Milan, Italy.
Correspondence to: D. Erkan, The Barbara Volcker Center for Women and Rheumatic Disease, Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, USA. E-mail: erkand{at}hss.edu
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Abstract |
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Background. Recommendations for the treatment of aPL-positive patients with pregnancy morbidity are based on a limited number of well-designed clinical trials. However, the management of pregnant aPL-positive women still displays several open questions.
Objective. To determine the practice patterns of experienced physicians in the management of the controversial aspects of aPL pregnancies.
Methods. A questionnaire reproducing debated conditions was initially sent to the Advisory Board members (ABMs) of the 12th Congress of aPL and the Fifth Conference on Sex Hormones, Pregnancy and Rheumatic Diseases (Florence, Italy, April 2007), and then the same questionnaire was posted at the Hospital for Special Surgery (www.hss.edu) website and all attendees (ATS) of the above meetings were invited to participate via e-mail. Answers have been collected and analysed in a descriptive fashion and responses of the two groups evaluated by Chi-square or Fisher's exact test.
Results. As a whole 75 responses from the ABMs and ATS were included in the analysis. In general, there was no significant difference between the opinions of two groups.
Conclusions. Management recommendations displayed reasonable consistence: (i) for the use of low-dose aspirin and low-molecular weight heparin during pregnancy and during ovarian stimulation for in vitro fertilization; (ii) against oestrogen-containing oral contraceptives; and (iii) for the use of anticoagulants in the post-partum period.
KEY WORDS: Antiphospholipid syndrome, Lupus anticoagulant, Pregnancy, In vitro fertilization, Aspirin, Heparin
Submitted 18 March 2008; Accepted 2 April 2008
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