Multicenter Study

. 2019 Apr;126(5):656-661.

doi: 10.1111/1471-0528.15469. Epub 2018 Oct 24.

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 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.

PMID: 30222236
PMCID: PMC7382947
DOI: 10.1111/1471-0528.15469

Multicenter Study

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 et al. BJOG. 2019 Apr.

. 2019 Apr;126(5):656-661.

doi: 10.1111/1471-0528.15469. Epub 2018 Oct 24.

Authors

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.

PMID: 30222236
PMCID: PMC7382947
DOI: 10.1111/1471-0528.15469

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.

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Figures

**Figure 1.. Global Antiphospholipid Syndrome (APS) Score Based on Obstetric APS (OAPS) versus Obstetric and Thrombotic APS (O+T APS).**
Data are shown as box plots, where each box represents the 25th–75th percentiles: lines inside the box represent the median. The whiskers represent the 95% CI. * Assessed by t-test

See this image and copyright information in PMC

Comment in

Obstetric APS and thrombosis; modelling future risks.
Spaanderman M, Ghossein-Doha C. Spaanderman M, et al. BJOG. 2019 Apr;126(5):662. doi: 10.1111/1471-0528.15595. Epub 2019 Feb 6. BJOG. 2019. PMID: 30592794 Free PMC article. No abstract available.

References

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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

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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

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