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Shannon M. Bates, MDCM; Ian A. Greer, MD, FCCP; Saskia Middeldorp, MD, PhD; David Veenstra, PharmD, PhD; Anne-Marie Prabulos, MD; Per Olav Vandvik, MD, PhD
Author and Funding Information

Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Bates has received honoraria for lectures from Leo Pharma, Inc (anticoagulant manufacturer), Sanofi-Aventis Canada (anticoagulant manufacturer), Boehringer Ingelheim GmbH (anticoagulant manufacturer), and Thrombosis Education, Ltd. Dr Greer has received honoraria for lectures and advisory board contributions from Leo Pharma and Sanofi-Aventis. Dr Middeldorp has received unrestricted research funding from GlaxoSmithKline plc and MedaPharma for the ALIFE study and has received speakers fees from GlaxoSmithKline plc; Boehringer Ingelheim GmbH; Bayer Healthcare Pharmaceuticals; and Leo Pharma, Inc. Dr Vandvik is a member of and prominent contributor to the GRADE Working Group. Drs Veenstra and Prabulos have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article. The authors of these guidelines provided detailed conflict of interest information which can be found online.2

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(2):545-546. doi:10.1378/chest.12-0948
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To the Editor:

We agree that the International Consensus Classification Criteria1 state that antiphospholipid antibody syndrome can be diagnosed in women with persistent positivity for a lupus anticoagulant (nonspecific inhibitor) or moderate to high titer antibodies to IgG or IgM anticardiolipin or β2-glycoprotein I, and with recurrent early pregnancy loss, late pregnancy loss, or premature birth because of eclampsia, severe preeclampsia, or placental insufficiency. We also state in our article that there is convincing evidence that antiphospholipid antibodies are associated with an increased risk of recurrent early loss and late pregnancy loss.2 However, as outlined in our article and in a recently published meta-analysis,3 current data do not support a consistent association between antiphospholipid antibodies and the other pregnancy complications that form the basis of the International Consensus Classification Criteria.

Although there is reasonable evidence to support the use of aspirin and either low-molecular-weight heparin or unfractionated heparin in pregnant women with antiphospholipid antibodies and recurrent early pregnancy loss, similar data to support antithrombotic therapy in women who meet the criteria discussed here on the basis of other placenta-mediated pregnancy complications are absent.2,3 Thrombophilia testing should only be performed when it has the potential to result in a change in patient management.4 Given the absence of a consistent association between antiphospholipid antibodies and eclampsia, preeclampsia, or placental insufficiency, and the lack of data supporting antithrombotic intervention in these patients, as well as those with late loss, we respectfully suggest that it would be inappropriate to recommend testing for the presence of antiphospholipid antibodies in women with pregnancy complications other than recurrent early loss.

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]
 
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]
 
Abou-Nassar K, Carrier M, Ramsay T, Rodger MA. The association between antiphospholipid antibodies and placenta mediated complications: a systematic review and meta-analysis. Thromb Res. 2011;128(1):77-85. [CrossRef] [PubMed]
 
Middeldorp S. Is thrombophilia testing useful?. Hematology Am Soc Hematol Educ Program. 2011;2011:150-155. [CrossRef] [PubMed]
 

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References

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]
 
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]
 
Abou-Nassar K, Carrier M, Ramsay T, Rodger MA. The association between antiphospholipid antibodies and placenta mediated complications: a systematic review and meta-analysis. Thromb Res. 2011;128(1):77-85. [CrossRef] [PubMed]
 
Middeldorp S. Is thrombophilia testing useful?. Hematology Am Soc Hematol Educ Program. 2011;2011:150-155. [CrossRef] [PubMed]
 
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