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A. Tiede et al.
appeared to be low (2 patients). We do not, therefore, rec- ommend a different approach for IST in pregnancy-asso- ciated AHA, except for more careful consideration regard- ing the use of cytotoxic agents in women of childbearing age because of the potential of these drugs to reduce fer- tility and cause embryotoxicity.
In women with pregnancy-associated AHA, we suggest the same approach for IST as in other patients, but with more careful consideration regarding the use of cytotoxic agents (GRADE 2C).
Thromboprophylaxis
Cardiovascular events, including thrombosis, myocardial infarction and stroke, were recorded as the cause of death in 6−7% of patients with AHA in the GTH and SACHA registries.9,10 It therefore appears justified to recommend thromboprophylaxis according to the 2018 American
Society of Hematology (ASH) guidelines in non-bleeding patients whose FVIII:C has returned to normal.76 If an indi- cation for antiplatelet drugs (e.g., history of myocardial infarction or stroke) or oral anticoagulants (e.g., atrial fibril- lation, artificial heart valves or recurrent venous throm- boembolism) exists, the use of these drugs should be initi- ated after FVIII has returned to normal levels.
We recommend thromboprophylaxis according to ASH guide- lines if FVIII:C has returned to normal levels. If indicated, therapy with anti-platelet drugs or oral anticoagulants should be initiated, after normal FVIII:C levels have been achieved (GRADE 1C).
Acknowledgments
Editorial support was provided by Physicians World GmbH, Mannheim, Germany, supported by Novo Nordisk Health Care AG, Zürich, Switzerland.
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