• Jaume Alijotas-Reig, Enrique Esteve-Valverde, Raquel Ferrer-Oliveras, Luis Sáez-Comet, Elmina Lefkou, Arsène Mekinian, Cristina Belizna, Amelia Ruffatti, Angela Tincani, Josep Pardos-Gea, Cecilia Nalli, Luca Marozio, Gerard Espinosa, Sara De Carolis, Omar Latino, Udry Sebastian, Elisa LLurba, Laura Trespidi, Cecilia Chighizola, Vittorio Pengo, Patrizia Rovere-Querini, Valentina Canti, Karoline Mayer-Pickel, Tatiana Reshetnyak, Sara Tabacco, Anna Arnau, and EUROAPS Study Group.
• From the Systemic Autoimmune Disease Unit, Department of Internal Medicine, Vall d'Hebron University Hospital, Department of Medicine, Universitat Autonoma (JA-R, JP-G), Internal Medicine Department, Althaia Healthcare University Network of Manresa, Systemic Autoimmune Disease Unit, Manresa (EE-V), High Risk Unit, Obstetric Department, Quirón University Hospital, Barcelona (RF-O), Internal Medicine Department, Miguel Servet University Hospital, Zaragoza, Spain (LS-C), Haematology Unit, Hippokration Hospital of Thessaloniki, Greece (EL), AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Universités, UPMC University, Paris (AM), Vascular and Coagulation Department, University Hospital Angers, Angers, France (CB), Rheumatology Unit, Department of Clinical and Experimental Medicine Azienda Ospedaliera, University of Padua, Padua (AR), Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Spedali Civili, Brescia (AT, CN), Department of Obstetrics and Gynaecology, Università di Torino, Torino, Italy (LM), Systemic Autoimmune Diseases Service, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain (GE), Department of Gynaecology, Gemmelli Hospital, Catholic University, Rome, Italy (SDeC), Autoimmune, Thrombophilic Diseases and Pregnancy Division, Dr Carlos G Durand Hospital, Buenos Aires, Argentina (OL, US), Obstetrics and Gynaecology Department, High Risk Unit, University Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (ELL), Immunorheumatology Research Laboratory, Istituto Auxologico Italiano (LT), Division of Rheumatology, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy (CC), Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua (VP), Pregnancy and Rheumatic Diseases Clinic Unit of Medicine and Clinical Immunology IRCCS Ospedale San Raffaele Università Vita-Salute San Raffaele, Milano, Italy (PR-Q, VC), Department of Obstetrics, Medical University Graz, Graz, Austria (KM-P), Department of Systemic Rheumatic Disease, V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia (TR), Department of Gynecology Obstetrics and Urology, "Sapienza" University of Rome, Rome, Italy (ST) and Clinical Research Unit, Althaia Healthcare University Network of Manresa, Barcelona, Catalonia Central University, Manresa-Vic, Spain (AA).
• Eur J Anaesthesiol. 2021 Sep 1; 38 (9): 916-922.

BackgroundThe combination of low-dose aspirin (LDA) and low-molecular-weight heparin (LMWH) until the end of gestation are the currently the accepted standard of care for the treatment of antiphospholipid-related obstetric disorders. In refractory cases, hydroxychloroquine (HCQ) can be added to this standard of care.ObjectiveTo evaluate the haemostatic safety of LDA and LMWH (medium to high prophylactic doses) during pregnancy and the puerperium in women with both full-blown obstetric antiphospholipid syndrome (OAPS) (Sydney criteria) and noncriteria - incomplete - OAPS.Study DesignRetrospective/prospective multicentre observational study. Obstetric background, laboratory categories, delivery mode, antithrombotic regimens and bleeding complications were compared.SettingA total of 30 tertiary European hospitals.PatientsMainly, Caucasian/Arian pregnant women were included. Other ethnicities were minimally present. Women were controlled throughout pregnancy and puerperium.Main Outcome MeasuresThe primary end-point was to evaluate the number of major and minor haemorrhagic complications in this cohort of women. Neuraxial anaesthetic bleeding complications were particularly assessed. Secondly, we aimed to compare local/general bleeding events between groups.ResultsWe studied 1650 women, of whom 1000 fulfilled the Sydney criteria of the OAPS and 650 did not (noncriteria OAPS). Data on antithrombotic-related complications were available in 1075 cases (65.15%). Overall, 53 (4.93%) women had bleeding complications, with 34 being considered minor (3.16%) and 19 major (1.76%). Neither obstetric complications nor laboratory categories were bleeding-related. Assisted vaginal delivery and caesarean section were related to local haemorrhage. Heparin doses and platelet count were not associated with major bleeding.ConclusionsLDA and medium to high prophylactic LMWH during pregnancy in women with full-blown OAPS/noncriteria OAPS are safe. A slight increase in bleeding risk was noted in instrumental deliveries. No women who underwent spinal or epidural anaesthesia suffered bleeding complications. No haemorrhage was observed in cases where HCQ was added to standard therapy.Copyright © 2021 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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