title: [Obstetrical APS: Is there a place for additional treatment to aspirin-heparin combination?]
abstract: Obstetrical APS is defined by thrombosis and/or obstetrical morbidity associated with persistent antiphospholipid antibodies. The aspirin and low molecular weighted heparin combination dramatically improved obstetrical outcome in APS patients. Several factors could be associated with obstetrical prognosis, as previous history of thrombosis, associated SLE, the presence of lupus anticoagulant and triple positivity of antiphospholipid antibodies. Obstetrical APS with isolated recurrent miscarriages is mostly associated with isolated anticardiolipids antibodies and have better obstetrical outcome. The pregnancy loss despite aspirin and heparin combination define the refractory obstetrical APS, and the prevalence could be estimated to 20-39%. Several other treatments have been used in small and open labeled studies, as steroids, intravenous immunoglobulins, plasma exchanges and hydroxychloroquine to improve the obstetrical outcome. Some other drugs as eculizumab and statins could also have physiopathological rational, but studies are necessary to define the place of these various drugs.
authors.affiliation: AP-HP, hôpital Saint-Antoine, service de médecine interne et l'inflammation-(DHU i2B), université Paris 06, 184, rue Faubourg-Saint-Antoine, 75012 Paris, France. Electronic address: arsene.mekinian@aphp.fr.
authors.forename: A
authors.initials: A
authors.lastname: Mekinian
authors.affiliation: AP-HP, hôpital Trousseau, service d'obstétrique, université de Paris 06, 75012 Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Kayem
authors.affiliation: AP-HP, hôpital Tenon, service d'obstétrique et de procréation médicalement assistée, université Paris 06, UMRS-938, 75020 Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Cohen
authors.affiliation: AP-HP, hôpital Jean-Verdier, service d'obstétrique, université Paris 13, 93300 Bondy, France.
authors.forename: L
authors.initials: L
authors.lastname: Carbillon
authors.affiliation: AP-HP, hôpital Saint-Antoine, service de médecine interne et l'inflammation-(DHU i2B), université Paris 06, 184, rue Faubourg-Saint-Antoine, 75012 Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Abisror
authors.affiliation: AP-HP, hôpital Saint-Antoine, service de médecine interne et l'inflammation-(DHU i2B), université Paris 06, 184, rue Faubourg-Saint-Antoine, 75012 Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Josselin-Mahr
authors.affiliation: AP-HP, hôpital Bichat, auto-immunité et hypersensibilité, université Paris 7, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Bornes
authors.affiliation: AP-HP, hôpital Saint-Antoine, service de médecine interne et l'inflammation-(DHU i2B), université Paris 06, 184, rue Faubourg-Saint-Antoine, 75012 Paris, France.
authors.forename: O
authors.initials: O
authors.lastname: Fain
mesh_terms: D000026:Abortion, Habitual / Q000276:immunology; D016736:Antiphospholipid Syndrome / Q000150:complications / Q000188:drug therapy*; D001241:Aspirin / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000276:immunology*; D011256:Pregnancy Outcome
chemical_list: D006493:Heparin; D001241:Aspirin
keywords: Associated immunomodulation; Obstetrical APS; Refractory; Réfractaire; SAPL obstétrical; Traitement; Traitements immunomodulateurs; Treatment