{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T21:05:10Z","timestamp":1777928710046,"version":"3.51.4"},"reference-count":24,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2018,7,17]],"date-time":"2018-07-17T00:00:00Z","timestamp":1531785600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health","award":["R01-AR49772"],"award-info":[{"award-number":["R01-AR49772"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Lupus"],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The purpose of this study was to evaluate the safety of antithrombotic treatments prescribed during pregnancy in patients with antiphospholipid syndrome (APS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This international, multicenter study included two cohorts of patients: a retrospective French cohort and a prospective US cohort (PROMISSE study). Inclusion criteria were (1) APS (Sydney criteria), (2) live pregnancy at 12 weeks of gestation (WG) with (3) follow-up data until six weeks post-partum. According to APS standard of care, patients were treated with aspirin and\/or low-molecular weight heparin (LMWH) at prophylactic (pure obstetric APS) or therapeutic doses (history of thrombosis). Major bleeding was defined as abnormal blood loss during the pregnancy and\/or post-partum period requiring intervention for hemostasis or transfusion, or during the peripartum period greater than 500\u2009mL and\/or requiring surgery or transfusion. Other bleeding events were classified as minor.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Two hundred and sixty-four pregnancies (87 prospectively collected) in 204 patients were included (46% with history of thrombosis, 23% with associated systemic lupus). During pregnancy, treatment included LMWH ( n\u2009=\u2009253; 96%) or low-dose aspirin ( n\u2009=\u2009223; 84%), and 215 (81%) patients received both therapies. The live birth rate was 89% and 82% in the retrospective and prospective cohorts, respectively. Adverse pregnancy outcomes occurred in 28% of the retrospective cohort and in 40% of the prospective cohort. No maternal death was observed in either cohort. A combined total of 45 hemorrhagic events (25%) occurred in the retrospective cohort, but major bleeding was reported in only six pregnancies (3%). Neither heparin nor aspirin alone nor combined therapy increased the risk of hemorrhage. We also did not observe an increased rate of bleeding in the case of a short interval between last LMWH (less than 24 hours) or aspirin (less than five days) doses and delivery. Only emergency Caesarean section was significantly associated with an increased risk of bleeding (odds ratio (OR) 5.03 (1.41\u201317.96); p=.016). In the prospective cohort, only one minor bleeding event was reported (vaginal bleeding).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our findings support the safety of antithrombotic therapy with aspirin and\/or LMWH during pregnancy in high-risk women with APS, and highlight the need for better treatments to improve pregnancy outcomes in APS. PROMISSE Study ClinicalTrials.gov identifier: NCT00198068.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0961203318787032","type":"journal-article","created":{"date-parts":[[2018,7,18]],"date-time":"2018-07-18T07:45:41Z","timestamp":1531899941000},"page":"1679-1686","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":27,"title":["Bleeding complications and antithrombotic treatment in 264 pregnancies in antiphospholipid syndrome"],"prefix":"10.1177","volume":"27","author":[{"given":"C M","family":"Yelnik","sequence":"first","affiliation":[{"name":"INSERM U995 LIRIC-Inflammation Research International Centre, CHU Lille, D\u00e9partement de M\u00e9decine Interne et d'Immunologie clinique, Centre National de R\u00e9f\u00e9rence Maladies Syst\u00e9miques et Auto-Immunes Rares, European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases (ReCONNECT), University of Lille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M","family":"Lambert","sequence":"additional","affiliation":[{"name":"INSERM U995 LIRIC-Inflammation Research International Centre, CHU Lille, D\u00e9partement de M\u00e9decine Interne et d'Immunologie clinique, Centre National de R\u00e9f\u00e9rence Maladies Syst\u00e9miques et Auto-Immunes Rares, European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases (ReCONNECT), University of Lille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E","family":"Drumez","sequence":"additional","affiliation":[{"name":"CHU Lille, EA 2694 \u2013 Sant\u00e9 publique: \u00e9pid\u00e9miologie et qualit\u00e9 des soins, D\u00e9partement de Biostatistique, University of Lille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"V","family":"Le Guern","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine Interne, Centre de R\u00e9f\u00e9rence des Maladies Syst\u00e9miques et Auto-Immunes Rares, H\u00f4pital Cochin, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J-L","family":"Bacri","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine Interne, Centre Hospitalier de Valenciennes, Valenciennes, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M M","family":"Guerra","sequence":"additional","affiliation":[{"name":"Rheumatology, Hospital for Special Surgery, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C A","family":"Laskin","sequence":"additional","affiliation":[{"name":"University of Toronto and Trio Fertility, Toronto, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D W","family":"Branch","sequence":"additional","affiliation":[{"name":"University of Utah and Intermountain Healthcare, Salt Lake City, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L R","family":"Sammaritano","sequence":"additional","affiliation":[{"name":"Rheumatology, Hospital for Special Surgery, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N","family":"Morel","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine Interne, Centre de R\u00e9f\u00e9rence des Maladies Syst\u00e9miques et Auto-Immunes Rares, H\u00f4pital Cochin, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G","family":"Guettrot-Imbert","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine Interne, Centre de R\u00e9f\u00e9rence des Maladies Syst\u00e9miques et Auto-Immunes Rares, H\u00f4pital Cochin, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D","family":"Launay","sequence":"additional","affiliation":[{"name":"INSERM U995 LIRIC-Inflammation Research International Centre, CHU Lille, D\u00e9partement de M\u00e9decine Interne et d'Immunologie clinique, Centre National de R\u00e9f\u00e9rence Maladies Syst\u00e9miques et Auto-Immunes Rares, European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases (ReCONNECT), University of Lille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E","family":"Hachulla","sequence":"additional","affiliation":[{"name":"INSERM U995 LIRIC-Inflammation Research International Centre, CHU Lille, D\u00e9partement de M\u00e9decine Interne et d'Immunologie clinique, Centre National de R\u00e9f\u00e9rence Maladies Syst\u00e9miques et Auto-Immunes Rares, European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases (ReCONNECT), University of Lille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P-Y","family":"Hatron","sequence":"additional","affiliation":[{"name":"INSERM U995 LIRIC-Inflammation Research International Centre, CHU Lille, D\u00e9partement de M\u00e9decine Interne et d'Immunologie clinique, Centre National de 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