Antiphospholipid Syndrome
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Published:
Nov 25, 2019
Keywords:
Antiphospholipid antibodies, Antiphospholipid syndrome, Autoimmune diseases, Pregnancy complications
Main Article Content
Abstract
Antiphospholipid syndrome (APS) was characterized as an autoimmune condition with the production of antiphospholipid antibodies (aPL) associated with thrombosis and morbidity in pregnancy. The prevalence of aPL in the population ranges from 1% to 5% in patients with APS. The hypotheses regarding pathophysiological mechanisms are strongly related to binding proteins and antiphospholipid antibodies. The exact mechanisms by which they lead to clinical manifestations appear to be heterogeneous, but it is believed which aPL contribute to the cellular activation/coagulation, and so cause the thrombotic events. The treatment of APS should be an individual character and several factors should be taken into accounts, such as a number of antibodies, the age of the patient and the history of thrombotic events.
Article Details
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1.
Santos T da S, Demarchi IG, Mello TFP, Teixeira JJV, Lonardoni MVC. Antiphospholipid Syndrome. Health Sci J [Internet]. 2019Nov.25 [cited 2024May4];9(4):37-2. Available from: https://portalrcs.hcitajuba.org.br/index.php/rcsfmit_zero/article/view/892
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References
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3. 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 antiphos- pholipid syndrome (APS). J Thromb Haemost. 2006;4(2):295-306. Doi: 10.1111/j.1538- 7836.2006.01753.x
4. Mehrani T, Petri M. Epidemiology of the antiphospholipid syndrome. In: Asherson RA, editor. Handbook of sys- temic autoimmune diseases. Vol. 10. Amsterdam: Else- vier; 2009. pp. 13–34.
5. Andreoli L, Chighizola CB, Banzato A, Pons-Estel GJ, de Je- sus GR, Erkan D. Estimated frequency of antiphospho- lipid antibodies in patients with pregnancy morbidity, stroke, myocardial infarction, and deep vein thrombosis: a critical review of the literature. Arthritis Care Res (Ho- boken). 2013;65(11):1869-73.
6. Cervera R, Piette JC, Font J, Khamashta MA, Shoenfeld Y, Camps MT, et al. Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease ex- pression in a cohort of 1,000 patients. Arthritis Rheum. 2002;46(4):1019-27. doi: 10.1002/art.10187
1. 7.Kaul M, Erkan D, Sammaritano L, Lockshin MD. Assess- ment of the 2006 revised antiphospholipid syndrome classification criteria. Ann Rheum Dis. 2007;66(7):927- 30. Doi: 10.1136/ard.2006.067314
7. Sebastiani GD, Galeazzi M, Morozzi G, Marcolongo R. The immunogenetics of the antiphospholipid syndrome, anti- cardiolipin antibodies, and lupus anticoagulant. Semin Arthritis Rheum. 1996;25(6):414-20. doi: 10.1016/s0049-0172(96)80006-0
2. 9.Galarza-Maldonado C, Kourilovitch MR, Pérez-Fer- nández OM, Gaybor M, Cordero C, Cabrera S, et al. Obste- tric antiphospholipid syndrome. Autoimmun Rev. 2012;11(4):288-95. Doi: 10.1016/j.autrev.2011.10.006
3. 10.Figueiró-Filho EA, de Oliveira VM, Breda I, Coelho LR, Ferreira CM. Usefulness of a scoring system on perinatal outcomes in pregnant women with thrombophilia in the effectiveness of an enoxaparin-based intervention. Rev Bras Ginecol Obstet. 2012;34(10):459-65. doi: 10.1590/s0100-72032012001000005
4. 11.Hughes GR. Thrombosis, abortion, cerebral disease, and the lupus anticoagulant. BMJ (Clin Res Ed). 1983;287(6399):1088-9. doi: 10.1136/bmj.287.6399.1088
5. 12.Wassermann A, Neisser A, Bruck C. Eine serodiagnos- tische reaktion bei syphilis [German]. Dtsch Med Woch- enschr. 1906;32(19):745-6. doi: 10.1055/s-0028- 1142018
6. 13.Pangborn MC. A new serologically active phospholipid from beef heart. Proceedings of the Society for Experi- mental Biology and Medicine. 1941;48(2):484-6. doi: 10.3181/00379727-48-13365P
of abortion, placental insufficiency, preterm delivery, preeclampsia, and gestational thrombosis.
7. 14.Nelson RA, Mayer MM. Immobilization of Treponema pallidum in vitro by antibody produced in syphilitic in- fection. J Exp Med. 1949;89(4):369-93. doi: 10.1084/jem.89.4.369
8. 15.Moore JE, Mohr CF. Biologically false positive sero- logic tests for syphilis: type, incidence, and cause. J Am Med Assoc. 1952;150(5):467-73. doi: 10.1001/jama.1952.03680050033010
9. 16.Conley CL, Hartmann RC. A hemorrhagic disorder caused by circulating anticoagulant in patients with dis- seminated lupus erythematosus. J Clin Invest. 1952;31:621-2.
10. 17.Feinstein DI, Rapaport SI. Acquired inhibitors of blood coagulation. Prog Hemost Thromb. 1972;1:75-95.
11. 18.Jude B, Goudemand J, Dolle I, Caron C, Watel A, Tiry C, et al. Lupus anticoagulant: a clinical and laboratory study of 100 cases. Clin Lab Haematol. 1988;10(1):41-51. doi: 10.1111/j.1365-2257.1988.tb01152.x
12. 19.Laurell AB, Nilsson IM. Hypergammaglobulinemia, circulating anticoagulant, and biologic false positive Was- sermann reaction: a study in two cases. J Lab Clin Med. 1957;49(5):694-707.
13. 20.Nigel HE. History of the antiphospholipid syndrome. Rev Colomb Reumatol. 2009;16(4):326-9. Available from: http://www.scielo.org.co/sci- elo.php?script=sci_arttext&pid=S0121- 81232009000400001&lng=en
14. 21.Levine JS, Branch DW, Rauch J. The antiphospholipid syndrome. N Engl J Med. 2002;346(10):752-63. doi: 10.1056/NEJMra002974
15. 22.Mackworth-Young CG. Antiphospholipid syndrome: multiple mechanisms. Clin Exp Immunol. 2004;136(3):393-401. doi: 10.1111/j.1365- 2249.2004.02497.x
16. 23.Meroni PL, Del Papa N, Borghi MO. Antiphospholipid and antiendothelial antibodies. Int Arch Allergy Immu- nol. 1996;111(4):320-5. doi: 10.1159/000237387
17. 24.Cugno M, Cabibbe M, Galli M, Meroni PL, Caccia S, Russo R, et al. Antibodies to tissue-type plasminogen ac- tivator (tPA) in patients with antiphospholipid syn- drome: evidence of interaction between the antibodies and the catalytic domain of tPA in 2 patients. Blood. 2004;103(6):2121-6. doi: 10.1182/blood-2003-07-2422
18. 25.Aron AL, Gharavi AE, Shoenfeld Y. Mechanisms of ac- tion of antiphospholipid antibodies in the antiphospho- lipid syndrome. Int Arch Allergy Immunol. 1995;106(1):8-12. doi: 10.1159/000236883
19. 26.Robbins DL, Leung S, Miller-Blair DJ, Ziboh V. Effect of anticardiolipin/beta2-glycoprotein I complexes on pro- duction of thromboxane A2 by platelets from patients with the antiphospholipid syndrome. J Rheumatol. 1998;25(1):51-6.
20. 27.Mackworth-Young CG, Andreotti F, Harmer I, Loizou S, Pottinger BE, Pearson JD, et al. Endothelium-derived hae- mostatic factors and the antiphospholipid syndrome. Br J Rheumatol. 1995;34(3):201-6. doi: 10.1093/rheumatol- ogy/34.3.201
Revista Ciências em Saúde v9, n4, 2019 15
21. 28.Gonias SL, Pizzo SV. The biochemistry of haemostasis. Clin Lab Haematol. 1986;8(4):281-306. doi: 10.1111/j.1365-2257.1986.tb00116.x
22. 29. de Groot PG, Horbach DA, Derksen R. Protein C and other cofactors involved in the binding of antiphospho- lipid antibodies: relation to the pathogenesis of throm- bosis. Lupus. 1996;5(5):488-93. doi: 10.1177/096120339600500532
23. 30.Matsuda J, Saitoh N, Gohchi K, Gotoh M, Tsukamoto AM. Anti-annexin V antibody in systemic lupus erythema- tosus patients with lupus anticoagulant and/or anticardi- olipin antibody. Am J Hematol. 1994;47(1):56-8. doi: 10.1002/ajh.2830470112
24. 31.Rand JH. The antiphospholipid syndrome. Annu Rev Med. 2003;54(1):409-24. doi: 10.1146/an- nurev.med.54.101601.152412
25. 32.Violi F, Ferro D, Valesini G, Quintarelli C, Saliola M, Grandilli MA, et al. Tissue plasminogen activator inhibi- tor in patients with systemic lupus erythematosus and thrombosis. BMJ. 1990;300(6732):1099-102. doi: 10.1136/bmj.300.6732.1099
26. 33.Sanfelippo MJ, Drayna CJ. Prekallikrein inhibition as- sociated with the lupus anticoagulant: a mechanism of thrombosis. Am J Clin Pathol. 1982;77(3):275-9. doi: 10.1093/ajcp/77.3.275
27. 34.Greaves M. Antiphospholipid antibodies and throm- bosis. Lancet. 1999;353(9161):1348-53. doi: 10.1016/S0140-6736(98)10362-8
28. 35.Vinatier D, Dufour P, Cosson M, Houpeau JL. Antiphos- pholipid syndrome and recurrent miscarriages. Eur J Obstet Gynecol Reprod Biol. 2001;96(1):37-50. doi: 10.1016/s0301-2115(00)00404-8
29. 36.Di Simone N, Meroni PL, de Papa N, Raschi E, Caliandro D, De Carolis CS, et al. Antiphospholipid antibodies affect trophoblast gonadotropin secretion and invasiveness by binding directly and through adhered β2‐glycoprotein I. Arthritis Rheum. 2000;43(1):140-50. doi: 10.1002/1529-0131(200001)43:1%3C140::AID- ANR18%3E3.0.CO;2-P
30. 37.Creasy RK, Resnik R (eds). Creasy and Resnik’s mater- nal-fetal medicine: principles and practice. 5th ed. Hou- ston: Gulf Professional Publishing; 2004.
31. 38.Sebire NJ, Fox H, Backos M, Rai R, Paterson C, Regan L. Defective endovascular trophoblast invasion in primary antiphospholipid antibody syndrome-associated early pregnancy failure. Hum Reprod. 2002;17(4):1067-71. doi: 10.1093/humrep/17.4.1067
32. 39.Bose P, Kadyrov M, Goldin R, Hahn S, Backos M, Regan L, et al. Aberrations of early trophoblast differentiation
predispose to pregnancy failure: lessons from the anti- phospholipid syndrome. Placenta. 2006;27(8):869-75. doi: 10.1016/j.placenta.2005.09.007
33. 40.Van Horn JT, Craven C, Ward K, Branch DW, Silver RM. Histologic features of placentas and abortion specimens from women with antiphospholipid and antiphospho- lipid-like syndromes. Placenta. 2004;25(7):642-8. doi: 10.1016/j.placenta.2003.12.006
34. 41.Meroni PL. Pathogenesis of the antiphospholipid syn- drome: an additional example of the mosaic of autoim- munity. J Autoimmun. 2008;30(1-2):99-103. doi: 10.1016/j.jaut.2007.11.014
35. 42.Tincani A, Andreoli L, Chighizola C, Meroni PL. The in- terplay between the antiphospholipid syndrome and sys- temic lupus erythematosus. Autoimmunity 2009; 42(4):257-9. doi: 10.1080/08916930902827918
36. 43.Rand JH, Wu XX, Quinn AS, Taatjes DJ. The annexin A5- mediated pathogenic mechanism in the antiphospholipid syndrome: role in pregnancy losses and thrombosis. Lu- pus. 2010;19(4):460-9. doi: 10.1177/0961203310361485
37. 44.Empson MB, Lassere M, Craig JC, Scott JR. Prevention of recurrent miscarriage for women with antiphospho- lipid antibody or lupus anticoagulant. Cochrane Database Syst Rev. 2005; 18(2):CD002859. doi: 10.1002/14651858.CD002859.pub2
38. 45.Ruiz-Irastorza G, Crowther M, Branch W, Khamashta MA. Antiphospholipid syndrome. Lancet. 2010;376(9751):1498-509. doi: 10.1016/S0140- 6736(10)60709-X
39. 46.Petri M. Pathogenesis and treatment of the antiphos- pholipid antibody syndrome. Med Clin North Am. 1997;81(1):151-77. Doi: 10.1016/s0025- 7125(05)70509-5
40. 47.Figueiró-Filho EA, Vasconcelos MMd, Souza ROd, Silva TFd, Maia TL. Síndrome do anticorpo antifosfolipídio e gravidez. Femina. 2007;35(1):47-53.
41. 48.Carmona F, Azulay M, Creus M, Fábregues F, Puerto B, Balasch J, et al. Risk factors associated with fetal losses in treated antiphospholipid syndrome pregnancies: a mul- tivariate analysis. Am J Reprod Immunol. 2001;46(4):274-9. doi: 10.1034/j.1600-0897.2001.d01- 13.x
42. 49.Bates SM, Greer IA, Pabinger I, Sofaer S, Hirsh J. Ve- nous thromboembolism, thrombophilia, antithrombotic therapy, and pregnancy: American College of Chest Phy- sicians evidence-based clinical practice guidelines. Chest. 2008;133(6 Suppl):844S-86S. doi: 10.1378/chest.08- 0761
2. Hanly JG. Antiphospholipid syndrome: an overview. Cmaj. 2003;168(13):1675-82.
3. 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 antiphos- pholipid syndrome (APS). J Thromb Haemost. 2006;4(2):295-306. Doi: 10.1111/j.1538- 7836.2006.01753.x
4. Mehrani T, Petri M. Epidemiology of the antiphospholipid syndrome. In: Asherson RA, editor. Handbook of sys- temic autoimmune diseases. Vol. 10. Amsterdam: Else- vier; 2009. pp. 13–34.
5. Andreoli L, Chighizola CB, Banzato A, Pons-Estel GJ, de Je- sus GR, Erkan D. Estimated frequency of antiphospho- lipid antibodies in patients with pregnancy morbidity, stroke, myocardial infarction, and deep vein thrombosis: a critical review of the literature. Arthritis Care Res (Ho- boken). 2013;65(11):1869-73.
6. Cervera R, Piette JC, Font J, Khamashta MA, Shoenfeld Y, Camps MT, et al. Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease ex- pression in a cohort of 1,000 patients. Arthritis Rheum. 2002;46(4):1019-27. doi: 10.1002/art.10187
1. 7.Kaul M, Erkan D, Sammaritano L, Lockshin MD. Assess- ment of the 2006 revised antiphospholipid syndrome classification criteria. Ann Rheum Dis. 2007;66(7):927- 30. Doi: 10.1136/ard.2006.067314
7. Sebastiani GD, Galeazzi M, Morozzi G, Marcolongo R. The immunogenetics of the antiphospholipid syndrome, anti- cardiolipin antibodies, and lupus anticoagulant. Semin Arthritis Rheum. 1996;25(6):414-20. doi: 10.1016/s0049-0172(96)80006-0
2. 9.Galarza-Maldonado C, Kourilovitch MR, Pérez-Fer- nández OM, Gaybor M, Cordero C, Cabrera S, et al. Obste- tric antiphospholipid syndrome. Autoimmun Rev. 2012;11(4):288-95. Doi: 10.1016/j.autrev.2011.10.006
3. 10.Figueiró-Filho EA, de Oliveira VM, Breda I, Coelho LR, Ferreira CM. Usefulness of a scoring system on perinatal outcomes in pregnant women with thrombophilia in the effectiveness of an enoxaparin-based intervention. Rev Bras Ginecol Obstet. 2012;34(10):459-65. doi: 10.1590/s0100-72032012001000005
4. 11.Hughes GR. Thrombosis, abortion, cerebral disease, and the lupus anticoagulant. BMJ (Clin Res Ed). 1983;287(6399):1088-9. doi: 10.1136/bmj.287.6399.1088
5. 12.Wassermann A, Neisser A, Bruck C. Eine serodiagnos- tische reaktion bei syphilis [German]. Dtsch Med Woch- enschr. 1906;32(19):745-6. doi: 10.1055/s-0028- 1142018
6. 13.Pangborn MC. A new serologically active phospholipid from beef heart. Proceedings of the Society for Experi- mental Biology and Medicine. 1941;48(2):484-6. doi: 10.3181/00379727-48-13365P
of abortion, placental insufficiency, preterm delivery, preeclampsia, and gestational thrombosis.
7. 14.Nelson RA, Mayer MM. Immobilization of Treponema pallidum in vitro by antibody produced in syphilitic in- fection. J Exp Med. 1949;89(4):369-93. doi: 10.1084/jem.89.4.369
8. 15.Moore JE, Mohr CF. Biologically false positive sero- logic tests for syphilis: type, incidence, and cause. J Am Med Assoc. 1952;150(5):467-73. doi: 10.1001/jama.1952.03680050033010
9. 16.Conley CL, Hartmann RC. A hemorrhagic disorder caused by circulating anticoagulant in patients with dis- seminated lupus erythematosus. J Clin Invest. 1952;31:621-2.
10. 17.Feinstein DI, Rapaport SI. Acquired inhibitors of blood coagulation. Prog Hemost Thromb. 1972;1:75-95.
11. 18.Jude B, Goudemand J, Dolle I, Caron C, Watel A, Tiry C, et al. Lupus anticoagulant: a clinical and laboratory study of 100 cases. Clin Lab Haematol. 1988;10(1):41-51. doi: 10.1111/j.1365-2257.1988.tb01152.x
12. 19.Laurell AB, Nilsson IM. Hypergammaglobulinemia, circulating anticoagulant, and biologic false positive Was- sermann reaction: a study in two cases. J Lab Clin Med. 1957;49(5):694-707.
13. 20.Nigel HE. History of the antiphospholipid syndrome. Rev Colomb Reumatol. 2009;16(4):326-9. Available from: http://www.scielo.org.co/sci- elo.php?script=sci_arttext&pid=S0121- 81232009000400001&lng=en
14. 21.Levine JS, Branch DW, Rauch J. The antiphospholipid syndrome. N Engl J Med. 2002;346(10):752-63. doi: 10.1056/NEJMra002974
15. 22.Mackworth-Young CG. Antiphospholipid syndrome: multiple mechanisms. Clin Exp Immunol. 2004;136(3):393-401. doi: 10.1111/j.1365- 2249.2004.02497.x
16. 23.Meroni PL, Del Papa N, Borghi MO. Antiphospholipid and antiendothelial antibodies. Int Arch Allergy Immu- nol. 1996;111(4):320-5. doi: 10.1159/000237387
17. 24.Cugno M, Cabibbe M, Galli M, Meroni PL, Caccia S, Russo R, et al. Antibodies to tissue-type plasminogen ac- tivator (tPA) in patients with antiphospholipid syn- drome: evidence of interaction between the antibodies and the catalytic domain of tPA in 2 patients. Blood. 2004;103(6):2121-6. doi: 10.1182/blood-2003-07-2422
18. 25.Aron AL, Gharavi AE, Shoenfeld Y. Mechanisms of ac- tion of antiphospholipid antibodies in the antiphospho- lipid syndrome. Int Arch Allergy Immunol. 1995;106(1):8-12. doi: 10.1159/000236883
19. 26.Robbins DL, Leung S, Miller-Blair DJ, Ziboh V. Effect of anticardiolipin/beta2-glycoprotein I complexes on pro- duction of thromboxane A2 by platelets from patients with the antiphospholipid syndrome. J Rheumatol. 1998;25(1):51-6.
20. 27.Mackworth-Young CG, Andreotti F, Harmer I, Loizou S, Pottinger BE, Pearson JD, et al. Endothelium-derived hae- mostatic factors and the antiphospholipid syndrome. Br J Rheumatol. 1995;34(3):201-6. doi: 10.1093/rheumatol- ogy/34.3.201
Revista Ciências em Saúde v9, n4, 2019 15
21. 28.Gonias SL, Pizzo SV. The biochemistry of haemostasis. Clin Lab Haematol. 1986;8(4):281-306. doi: 10.1111/j.1365-2257.1986.tb00116.x
22. 29. de Groot PG, Horbach DA, Derksen R. Protein C and other cofactors involved in the binding of antiphospho- lipid antibodies: relation to the pathogenesis of throm- bosis. Lupus. 1996;5(5):488-93. doi: 10.1177/096120339600500532
23. 30.Matsuda J, Saitoh N, Gohchi K, Gotoh M, Tsukamoto AM. Anti-annexin V antibody in systemic lupus erythema- tosus patients with lupus anticoagulant and/or anticardi- olipin antibody. Am J Hematol. 1994;47(1):56-8. doi: 10.1002/ajh.2830470112
24. 31.Rand JH. The antiphospholipid syndrome. Annu Rev Med. 2003;54(1):409-24. doi: 10.1146/an- nurev.med.54.101601.152412
25. 32.Violi F, Ferro D, Valesini G, Quintarelli C, Saliola M, Grandilli MA, et al. Tissue plasminogen activator inhibi- tor in patients with systemic lupus erythematosus and thrombosis. BMJ. 1990;300(6732):1099-102. doi: 10.1136/bmj.300.6732.1099
26. 33.Sanfelippo MJ, Drayna CJ. Prekallikrein inhibition as- sociated with the lupus anticoagulant: a mechanism of thrombosis. Am J Clin Pathol. 1982;77(3):275-9. doi: 10.1093/ajcp/77.3.275
27. 34.Greaves M. Antiphospholipid antibodies and throm- bosis. Lancet. 1999;353(9161):1348-53. doi: 10.1016/S0140-6736(98)10362-8
28. 35.Vinatier D, Dufour P, Cosson M, Houpeau JL. Antiphos- pholipid syndrome and recurrent miscarriages. Eur J Obstet Gynecol Reprod Biol. 2001;96(1):37-50. doi: 10.1016/s0301-2115(00)00404-8
29. 36.Di Simone N, Meroni PL, de Papa N, Raschi E, Caliandro D, De Carolis CS, et al. Antiphospholipid antibodies affect trophoblast gonadotropin secretion and invasiveness by binding directly and through adhered β2‐glycoprotein I. Arthritis Rheum. 2000;43(1):140-50. doi: 10.1002/1529-0131(200001)43:1%3C140::AID- ANR18%3E3.0.CO;2-P
30. 37.Creasy RK, Resnik R (eds). Creasy and Resnik’s mater- nal-fetal medicine: principles and practice. 5th ed. Hou- ston: Gulf Professional Publishing; 2004.
31. 38.Sebire NJ, Fox H, Backos M, Rai R, Paterson C, Regan L. Defective endovascular trophoblast invasion in primary antiphospholipid antibody syndrome-associated early pregnancy failure. Hum Reprod. 2002;17(4):1067-71. doi: 10.1093/humrep/17.4.1067
32. 39.Bose P, Kadyrov M, Goldin R, Hahn S, Backos M, Regan L, et al. Aberrations of early trophoblast differentiation
predispose to pregnancy failure: lessons from the anti- phospholipid syndrome. Placenta. 2006;27(8):869-75. doi: 10.1016/j.placenta.2005.09.007
33. 40.Van Horn JT, Craven C, Ward K, Branch DW, Silver RM. Histologic features of placentas and abortion specimens from women with antiphospholipid and antiphospho- lipid-like syndromes. Placenta. 2004;25(7):642-8. doi: 10.1016/j.placenta.2003.12.006
34. 41.Meroni PL. Pathogenesis of the antiphospholipid syn- drome: an additional example of the mosaic of autoim- munity. J Autoimmun. 2008;30(1-2):99-103. doi: 10.1016/j.jaut.2007.11.014
35. 42.Tincani A, Andreoli L, Chighizola C, Meroni PL. The in- terplay between the antiphospholipid syndrome and sys- temic lupus erythematosus. Autoimmunity 2009; 42(4):257-9. doi: 10.1080/08916930902827918
36. 43.Rand JH, Wu XX, Quinn AS, Taatjes DJ. The annexin A5- mediated pathogenic mechanism in the antiphospholipid syndrome: role in pregnancy losses and thrombosis. Lu- pus. 2010;19(4):460-9. doi: 10.1177/0961203310361485
37. 44.Empson MB, Lassere M, Craig JC, Scott JR. Prevention of recurrent miscarriage for women with antiphospho- lipid antibody or lupus anticoagulant. Cochrane Database Syst Rev. 2005; 18(2):CD002859. doi: 10.1002/14651858.CD002859.pub2
38. 45.Ruiz-Irastorza G, Crowther M, Branch W, Khamashta MA. Antiphospholipid syndrome. Lancet. 2010;376(9751):1498-509. doi: 10.1016/S0140- 6736(10)60709-X
39. 46.Petri M. Pathogenesis and treatment of the antiphos- pholipid antibody syndrome. Med Clin North Am. 1997;81(1):151-77. Doi: 10.1016/s0025- 7125(05)70509-5
40. 47.Figueiró-Filho EA, Vasconcelos MMd, Souza ROd, Silva TFd, Maia TL. Síndrome do anticorpo antifosfolipídio e gravidez. Femina. 2007;35(1):47-53.
41. 48.Carmona F, Azulay M, Creus M, Fábregues F, Puerto B, Balasch J, et al. Risk factors associated with fetal losses in treated antiphospholipid syndrome pregnancies: a mul- tivariate analysis. Am J Reprod Immunol. 2001;46(4):274-9. doi: 10.1034/j.1600-0897.2001.d01- 13.x
42. 49.Bates SM, Greer IA, Pabinger I, Sofaer S, Hirsh J. Ve- nous thromboembolism, thrombophilia, antithrombotic therapy, and pregnancy: American College of Chest Phy- sicians evidence-based clinical practice guidelines. Chest. 2008;133(6 Suppl):844S-86S. doi: 10.1378/chest.08- 0761