IVIG in APS pregnancy

Sezione di Reumatologia, Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy.
Lupus (Impact Factor: 2.2). 02/2004; 13(9):731-5. DOI: 10.1191/0961203304lu2011oa
Source: PubMed


For more than two decades, the intravenous administration of high doses of IgG pooled from the plasma of healthy donors (immune globulin therapy, also known as 'IVIG') has benefited patients with a variety of autoimmune disorders. A potential therapeutic role of IVIG in the prevention of thrombosis and of miscarriages in antiphospholipid syndrome (APS) has been postulated. Multicenter randomized controlled trials attempted to define the role of IVIG in preventing pregnancy complications in APS indicate that simple anticoagulation could not be completely satisfactory, and certain patient subgroups might take advantage of IVIG therapy alone or in combination with heparin.

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    ABSTRACT: We encountered a woman who had a history of repeated fetal losses and positive tests for lupus anticoagulant, phosphatidylserine-dependent antiprothrombin (aPS/PT) IgG, IgM and kininogen-dependent antiphosphatidylethanolamine (aPE) IgG, IgM. Her previous pregnancy had ended in intrauterine fetal death at 24weeks of gestation despite a therapy of low-dose aspirin, prednisolone and danaparoid. During the present pregnancy, she was treated with repeated intravenous infusions of immunoglobulin (IVIg) together with low-dose aspirin, prednisolone and heparin. When thrombocytopenia developed, she delivered a female baby weighing 2,152g at 34weeks of gestation by cesarean section. Titers of aPS/PT IgM and aPE IgM were reduced or maintained at low levels by repeated IVIg therapies. The IVIg therapy might be effective for aspirin-heparinoid-resistant antiphospholipid syndrome. KeywordsAntiphospholipid syndrome-Aspirin-Heparin-Heparinoid-Immunoglobulin
    No preview · Article · Dec 2010 · Reproductive Medicine and Biology
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    ABSTRACT: Antiphospholipid syndrome (APS) is an autoimmune disorder defined by the occurrence of venous and arterial thromboses and pregnancy morbidity, frequently accompanied by a moderate thrombocytopenia, in the presence of antiphospholipid antibodies. There is both laboratory and clinical evidence for the beneficial role of intravenous immunoglobulin (IVIg) in APS. Data on the use of IVIg in patients with APS have focused on its obstetric complications and antiphospholipid antibodies-positive patients undergoing in vitro fertilization, but there are also case reports about treatments of other clinical manifestations (mainly hematological) of the syndrome. Future research should determine when to use anticoagulation, IVIg, or both in the treatment of APS.
    No preview · Article · Jan 2006 · Clinical Reviews in Allergy & Immunology
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    ABSTRACT: Antiphospholipid antibodies are associated with a hypercoagulable state leading to a wide variety of systemic manifestations and obstetric complications. The different pathologic manifestations can be a result of arterial and venous thrombosis, microthrombotic angiopathy, embolization, obstetric disease, and non-thrombotic phenomenon. Presently, the treatment centers on anticoagulation. Two randomized prospective studies in patients with antiphospholipid syndrome with initial thromboembolic event support the target international normalized ratio of 2.0 to 3.0 for the prevention of future thrombotic events. With pregnancy, the combination of aspirin and heparin is still the standard of care. In addition, non-thrombotic features and any associated autoimmune disease may need to be treated. Underlying risk factors precipitating the thromboembolic phenomenon need to be addressed as well.
    No preview · Article · May 2006 · Current Rheumatology Reports
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