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Screening for Antiphospholipid Antibodies in Women With Pregnancy ComplicationsAntiphospholipid Antibodies Screening in Pregnancy FREE TO VIEW

Jose Antonio Gonzalez-Nieto, MD; Ignacio Martin-Suarez, MD
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Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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Chest. 2012;142(2):545. doi:10.1378/chest.12-0759
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To the Editor:

We read with great interest the article by Bates et al1 in an issue of CHEST (February 2012), in which the authors evaluate the evidence on the risk of pregnancy complications in women with thrombophilia. In this guideline article, the authors recommend screening for antiphospholipid antibodies in women with recurrent early pregnancy loss with a high level of evidence (Grade 1B).

The antiphospholipid syndrome is an autoimmune condition characterized by vascular thromboses (arterial and/or venous) and/or pregnancy morbidity in the presence of antiphospholipid antibodies. The pregnancy morbidity includes one unexplained fetal death (later than 10 weeks’ gestation); three or more unexplained consecutive miscarriages (before 10 weeks’ gestation); or one or more premature births of a morphologically normal neonate before the 34th week of gestation because of eclampsia, severe preeclampsia, or placental insufficiency. Evidence suggests that the fetal death Sapporo pregnancy morbidity criterion is the most specific, whereas the recurrent early abortion criterion may be the most sensitive,2 being lupus anticoagulant the greatest predictor of fetal loss after 24 weeks’ gestation.3 We suggest that there is strong evidence to recommend screening for antiphospholipid antibodies in women with late pregnancy loss and/or premature birth because of eclampsia, severe preeclampsia, or placental insufficiency.

Bates SM, Greer IA, Middeldorp S, Veenstra DL, Prabulos A-M, Vandvik PO. VTE, thrombophilia, antithrombotic therapy, and pregnancy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2)(suppl):e691S-e736S. [CrossRef] [PubMed]
 
Miyakis S, Lockshin MD, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006;4(2):295-306. [CrossRef] [PubMed]
 
Opatrny L, David M, Kahn SR, Shrier I, Rey E. Association between antiphospholipid antibodies and recurrent fetal loss in women without autoimmune disease: a metaanalysis. J Rheumatol. 2006;33(11):2214-2221. [PubMed]
 

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References

Bates SM, Greer IA, Middeldorp S, Veenstra DL, Prabulos A-M, Vandvik PO. VTE, thrombophilia, antithrombotic therapy, and pregnancy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2)(suppl):e691S-e736S. [CrossRef] [PubMed]
 
Miyakis S, Lockshin MD, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006;4(2):295-306. [CrossRef] [PubMed]
 
Opatrny L, David M, Kahn SR, Shrier I, Rey E. Association between antiphospholipid antibodies and recurrent fetal loss in women without autoimmune disease: a metaanalysis. J Rheumatol. 2006;33(11):2214-2221. [PubMed]
 
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