Factors associated with first thrombosis in patients presenting with obstetric antiphospholipid syndrome (APS) in the APS Alliance for Clinical Trials and International Networking Clinical Database and Repository: a retrospective study

G R de Jesús; S Sciascia; D Andrade; M Barbhaiya; M Tektonidou; A Banzato; V Pengo; L Ji; P L Meroni; A Ugarte; H Cohen; D W Branch; L Andreoli; H M Belmont; P R Fortin; M Petri; E Rodriguez; R Cervera; J S Knight; T Atsumi; R Willis; I S Nascimento; R Rosa; D Erkan; R A Levy; APS ACTION

doi:10.1111/1471-0528.15469

Factors associated with first thrombosis in patients presenting with obstetric antiphospholipid syndrome (APS) in the APS Alliance for Clinical Trials and International Networking Clinical Database and Repository: a retrospective study

BJOG. 2019 Apr;126(5):656-661. doi: 10.1111/1471-0528.15469. Epub 2018 Oct 24.

Authors

G R de Jesús¹, S Sciascia², D Andrade³, M Barbhaiya⁴, M Tektonidou⁵, A Banzato⁶, V Pengo⁶, L Ji⁷, P L Meroni⁸, A Ugarte⁹, H Cohen¹⁰, D W Branch¹¹, L Andreoli¹², H M Belmont¹³, P R Fortin¹⁴, M Petri¹⁵, E Rodriguez¹⁶, R Cervera¹⁷, J S Knight¹⁸, T Atsumi¹⁹, R Willis²⁰, I S Nascimento³, R Rosa³, D Erkan⁴, R A Levy^{21

22}; APS ACTION

Affiliations

¹ Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
² Department of Clinical and Biological Sciences, Centre of Research of Immunopathology and Rare Diseases, University of Turin, Turin, Italy.
³ Departament of Rheumatology, Universidade de São Paulo, São Paulo, Brazil.
⁴ Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA.
⁵ Rheumatology Unit, First Department of Propaedeutic Internal Medicine, University of Athens, Athens, Greece.
⁶ Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy.
⁷ Rheumatology and Immunology Department, Peking University, First Hospital, Beijing, China.
⁸ Department of Rheumatology, University of Milan, Milan, Italy.
⁹ Autoimmune Diseases Research Unit, Department of Internal Medicine, Hospital Universitario Cruces, Barakaldo, Spain.
¹⁰ Department of Haematology, University College London, London, UK.
¹¹ Department of Obstetrics and Gynecology, University of Utah Health Sciences and Intermountain Healthcare, Salt Lake City, UT, USA.
¹² Rheumatology and Clinical Immunology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
¹³ Division of Rheumatology, NYU School of Medicine, New York, NY, USA.
¹⁴ Division of Rheumatology, Centre Hospitalier de l'Université Laval, Québec, QC, Canada.
¹⁵ Division of Rheumatology, John Hopkins University, Baltimore, MD, USA.
¹⁶ Rheumatology Department, Hospital 12 de Octubre, Madrid, Spain.
¹⁷ Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain.
¹⁸ Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA.
¹⁹ Department of Rheumatology, Endocrinology, and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
²⁰ Antiphospholipid Standardization Laboratory, Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA.
²¹ Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
²² GlaxoSmithKline Immunology and Inflammation, Upper Providence, PA, USA.

Abstract

Objective: To evaluate the subsequent rate of thrombosis among women with obstetric antiphospholipid syndrome (Ob-APS) in a multicentre database of antiphospholipid antibody (aPL)-positive patients, and the clinical utility of the adjusted Global Antiphospholipid Syndrome Score (aGAPSS), a validated tool to assess the likelihood of developing new thrombosis, in this group of patients.

Design: Retrospective study.

Setting: The Antiphospholipid Syndrome Alliance for Clinical Trials and International Networking Clinical Database and Repository.

Population: Women with Ob-APS.

Methods: Comparison of clinical and laboratory characteristics and measurement of aGAPSS in women with Ob-APS, with or without thrombosis, after initial pregnancy morbidity (PM).

Main outcome measures: Risk factors for thrombosis and aGAPSS.

Results: Of 550 patients, 126 had Ob-APS; 74/126 (59%) presented with thrombosis, and 47 (63%) of these women developed thrombosis after initial PM, in a mean time of 7.6 ± 8.2 years (4.9/100 patient years). Younger age at diagnosis of Ob-APS, additional cardiovascular risk factors, superficial vein thrombosis, heart valve disease, and multiple aPL positivity increased the risk of first thrombosis after PM. Women with thrombosis after PM had a higher aGAPSS compared with women with Ob-APS alone [median 11.5 (4-16) versus 9 (4-13); P = 0.0089].

Conclusion: Based on a retrospective analysis of our multicentre aPL database, 63% of women with Ob-APS developed thrombosis after initial obstetric morbidity; additional thrombosis risk factors, selected clinical manifestations, and high-risk aPL profile increased the risk. Women with subsequent thrombosis after Ob-APS had a higher aGAPSS at entry to the registry. We believe that aGAPSS is a valid tool to improve risk stratification in aPL-positive women.

Tweetable abstract: More than 60% of women with obstetric antiphospholipid syndrome had thrombosis after initial pregnancy morbidity.

Keywords: Antiphospholipid antibodies; antiphospholipid syndrome; fetal death; miscarriage; pre-eclampsia; thrombosis.

Publication types

Evaluation Study
Multicenter Study

MeSH terms

Adult
Antibodies, Antiphospholipid / blood
Antibodies, Antiphospholipid / immunology
Antiphospholipid Syndrome / blood
Antiphospholipid Syndrome / complications*
Clinical Trials as Topic
Databases, Factual
Female
Humans
Pregnancy
Pregnancy Complications, Cardiovascular / immunology*
Registries
Retrospective Studies
Risk Factors
Thrombosis / immunology*

Substances

Antibodies, Antiphospholipid

Abstract

Publication types

MeSH terms

Substances

Grants and funding