Uso de la heparina de bajo peso molecular y aspirina en una paciente con síndrome antifosfolípido y pérdida gestacional recurrente
Resumen
Introducción: La pérdida gestacional recurrente (PGR) es una patología frecuente, que causa gran impacto en las parejas conllevando frustración, ansiedad, depresión, gastos excesivos y hasta rupturas de la relación de pareja. Su etiología es multicausal y frecuentemente no se logra determinar. Se presenta el caso de una paciente con PGR quien luego de seis pérdidas gestacionales, en el séptimo embarazo se detectaron anticuerpos antifosfolípidos altos, recibiendo tratamiento de tromboprofilaxis doble hasta la semana 32, obteniéndose un producto pretérmino vivo y sano que evolucionó satisfactoriamente. Se discuten dificultades para la precisión diagnóstica y las modalidades de tratamiento descritos.
Referencias bibliográficas
Kiwi R. Recurrent pregnancy loss: evaluation and discussion of the causes and their management. Cleve Clin J Med 2006; 73(10):913-21.
Stephenson M, Kutteh W. Evaluation and management of recurrent early pregnancy loss. Clin Obstet Gynecol 2007; 50(1):132-45.
Ford HB, Schust DJ. Recurrent pregnancy loss: etiology, diagnosis, and therapy. Rev Obstet Gynecol 2009;2(2):76-83.
Branch DW, Gibson M, Silver RM. Clinical practice. Recurrentmiscarriage.NEnglJMed2010;363(18):1740-7.
Ware Branch D, Eller AG. Antiphospholipid syndrome and thrombosis. Clin Obstet Gynecol 2006; 49(4):861-74.
Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, 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.
Kutteh WH. Recurrent pregnancy loss: an update. Curr Opin Obstet Gynecol 1999; 11(5):435-9.
BranchDW,SilverRM,PorterTF.Obstetric antiphospholipid syndrome: current uncertainties should guide our way. Lupus 2010;19(4):446-52.
Cervera R, Piette JC, Font J, Khamashta MA, Shoenfeld Y, Camps MT, et al. Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. Arthritis Rheum 2002; 46(4):1019-27.
Ruiz-Irastorza G, Crowther M, Branch W, Khamashta MA. Antiphospholipid syndrome. Lancet 2010;376(9751):1498-509.
ACOG Practice Bulletin No. 118: Antiphospholipid syndrome. Obstet Gynecol 2011; 117(1):192-9.
Bramham K, Hunt BJ, Germain S, Calatayud I, Khamashta M, Bewley S, et al. Pregnancy outcome in different clinical phenotypes of antiphospholipid syndrome. Lupus 2010;19(1):58-64.
Do Prado AD, Piovesan DM, Staub HL, Horta BL. Association of anticardiolipin antibodies with preeclampsia: a systematic review and meta-analysis. Obstet Gynecol 2010; 116(6):1433-43
Branch DW, Khamashta MA. Antiphospholipid syndrome: obstetric diagnosis, management, and controlled trial of aspirin and aspirin plus heparin in controversies. Obstet Gynecol 2003; 101(6):1333-44.
Carp HJ. Antiphospholipid syndrome in pregnancy. Curr Opin Obstet Gynecol 2004; 16(2):129-35.
Empson M, Lassere M, Craig J, Scott J. Prevention of recurrent miscarriage for women with antiphospholipid antibody or lupus anticoagulant. Cochrane Database Syst Rev 2005; 2(2):CD002859.
Ziakas PD, Pavlou M, Voulgarelis M. Heparin treatment in antiphospholipid syndrome with recurrent pregnancy loss: a systematic review and meta-analysis. Obstet Gynecol 2010; 115(6):1256-62.
Mark A, Cheung MW, Cheak AA, Ho RC. Combination of heparin and aspirin is superior to aspirin alone in enhancing live births in patients with recurrent pregnancy loss and positive anti-phospholipid antibodies: a meta-analysis of randomized controlled trials and meta-regression. Rheumatology (Oxford) 2010;49(2):281-8.
Greer IA. Antithrombotic treatment for recurrent pregnancy loss? J Thromb Haemost 2011;9 (Suppl 1):302-5.
Farquharson RG, Quenby S, Greaves M. Antiphospholipid syndrome in pregnancy: a randomized, controlled trial of treatment. Obstet Gynecol 2002;100(3):408-13.
Hoppe B, Burmester GR, Dorner T. Heparin or aspirin or both in the treatment of recurrent abortions in women with antiphospholipid antibody (syndrome). Curr Opin Rheumatol 2011; 23(3):299-304.
Wu S, Stephenson MD. Obstetrical antiphospholipid syndrome. Semin Reprod Med 2006; 24(1):40-53.
Rai R, Cohen H, Dave M, Regan L. Randomised controlled trial of aspirin and aspirin plus heparin in pregnant women with recurrent miscarriage associated with phospholipid antibodies (or antiphospholipid antibodies). BMJ 1997; 314(7076):253-7.
Di Simone N, Luigi MP, Marco D, Fiorella DN, Silvia D, Clara DM, etal. Pregnancies complicated with antiphospholipid syndrome: the pathogenic mechanism of antiphospholipid antibodies: a review of the literature. Ann N Y Acad Sci 2007; 1108:505-14.
Davis SM, Branch DW. Thromboprophylaxis in pregnancy: who and how? Obstet Gynecol Clin North Am Gynecol 2010;37(2):333-43.
Bates SM, Greer IA, Pabinger I, Sofaer S, Hirsh J. Venous thromboembolism, thrombophilia, antithrombotic therapy, and pregnancy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8Edition). Chest 2008;133(6 Suppl):844S-86S.
Espinosa G, Cervera R. Thromboprophylaxis and obstetric management of the antiphospholipid syndrome. Expert Opin Pharmacother 2009;10(4):601-14.
Deruelle P, Coulon C. The use of low-molecular-weight heparins in pregnancy--how safe are they? Curr Opin Obstet Gynecol 2007;19(6):573-7.
Quenby S, Farquharson RG, Dawood F, Hughes AM, Topping J. Recurrent miscarriage and long-term thrombosis risk: a case-control study. Hum Reprod 2005;20(6):1729-32.
Galli M, Luciani D, Bertolini G, Barbui T. Anti-beta 2-glycoprotein I, antiprothrombin antibodies, and the risk of thrombosis in the antiphospholipid syndrome. Blood 2003;102(8):2717-23.
Descargas
Derechos de autor 2022 MedUNAB
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial 4.0.
| Estadísticas de artículo | |
|---|---|
| Vistas de resúmenes | |
| Vistas de PDF | |
| Descargas de PDF | |
| Vistas de HTML | |
| Otras vistas | |
