For practical purposes, if you are told that you have a low PAPP-A that increases your baby’ s risk for Down syndrome and your baby turns out to be fine after the CVS, then you should ask your doctor to screen you for thrombophilia and treat you accordingly. Even in the absence of positive thrombophilia testing, with a 20% risk for fetal and neonatal death, treatment with anticoagulants is well justified even in the absence of clinical trials. It will take at least 15-20 years before “appropriate” studies are conducted to standardize such a treatment. At Kofinas Perinatal we cannot wait for such treatments. We develop them and use them while we save countless lives.