#5-40E. Low-Titer aPL Dilemma: Redefining Risk Stratification and Management in Obstetric APS (Rheumatology, 2024)

How do we balance the clinical scales when managing pregnant patients with antiphospholipid antibodies? This comprehensive review details the management of reproductive issues in women with antiphospholipid syndrome (APS) or asymptomatic carriers, emphasizing the clinical value of preconception counseling and individualized risk stratification. While a combination of low-dose aspirin and heparin remains the cornerstone of prophylaxis to prevent placental insufficiency, immunomodulators like hydroxychloroquine emerge as key adjuncts for refractory cases. Crucially, the authors highlight a major clinical paradigm shift: patients with low-titer or "non-criteria" antibody profiles do not experience milder phenotypes but carry a substantial risk of severe obstetric complications, benefiting significantly from standard prophylactic treatments. However, clinicians must critically note that many recommendations and management algorithms proposed in this review are still supported by small observational cohorts and retrospective registry data. Ultimately, this paper is vital for clinicians to navigate personalized treatment plans, schedule optimal delivery timing via rigorous ultrasound surveillance, and address postpartum thromboembolic and long-term cardiovascular risks in these patients.

Citation: Andreoli L, Regola F, Caproli A, Crisafulli F, Fredi M, Lazzaroni MG, Nalli C, Piantoni S, Zatti S, Franceschini F, Tincani A. Pregnancy in antiphospholipid syndrome: what should a rheumatologist know?. Rheumatology. 2024. DOI: 10.1093/rheumatology/kead537

URL: https://doi.org/10.1093/rheumatology/kead537

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