Screening for Antiphospholipid Antibodies in Women With Pregnancy Complications: Response

Abstract

We agree that the International Consensus Classification Criteria1Miyakis 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: 295-306Crossref PubMed Scopus (5195) Google Scholar 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.2Bates 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: e691S-e736SAbstract Full Text Full Text PDF PubMed Scopus (1075) Google Scholar However, as outlined in our article and in a recently published meta-analysis,3Abou-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: 77-85Abstract Full Text Full Text PDF PubMed Scopus (129) Google Scholar 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.2Bates 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: e691S-e736SAbstract Full Text Full Text PDF PubMed Scopus (1075) Google Scholar, 3Abou-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: 77-85Abstract Full Text Full Text PDF PubMed Scopus (129) Google Scholar Thrombophilia testing should only be performed when it has the potential to result in a change in patient management.4Middeldorp S Is thrombophilia testing useful?.Hematology Am Soc Hematol Educ Program. 2011; 2011: 150-155Crossref PubMed Scopus (98) Google Scholar 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. Screening for Antiphospholipid Antibodies in Women With Pregnancy ComplicationsCHESTVol. 142Issue 2PreviewWe 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). Full-Text PDF