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Long Term Follow up of Patients With Primary Obstetric Antiphospholipid Syndrome
Stanley Niznik1, Micha J Rapoport2,3, Orly Avnery4
1Clinical Immunology, Angioedema and Allergy Unit, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel.
Insights
Thrombotic events are common in women with primary antiphospholipid syndrome (APS), even those without initial thrombosis. Heart valve disease and ANA positivity may increase thrombosis risk in obstetric APS patients.
Area of Science:
- Rheumatology
- Obstetrics
- Hematology
Background:
- Primary obstetric antiphospholipid syndrome (OAPS) involves pregnancy complications and antiphospholipid antibodies (aPL).
- Long-term thrombotic event data for OAPS patients is limited.
- Antiphospholipid syndrome (APS) can present with obstetric complications (OAPS) or thrombosis (tAPS).
Purpose of the Study:
- To investigate the long-term occurrence of thrombotic events in patients with primary APS (pAPS).
- To compare thrombotic and obstetric outcomes between OAPS and thrombotic APS (tAPS) presentations.
- To identify risk factors for thrombosis in OAPS patients during follow-up.
Main Methods:
- Multi-center retrospective cohort study of 219 female patients with pAPS (2004-2019).
- Patients classified as OAPS or tAPS based on initial presentation.
- Comparison of clinical and serological data, including long-term follow-up for thrombotic events and obstetric morbidity.
Main Results:
- Over 10 years, 35.8% of OAPS and 50% of tAPS patients experienced new thrombotic events (p=0.06).
- Obstetric morbidity was significantly higher in the OAPS group (31.3% vs. 10.5%, p<0.001).
- In OAPS patients, heart valve disease and ANA positivity were linked to post-diagnosis thrombosis (p=0.02 and p=0.04, respectively).
Conclusions:
- Thrombotic events are frequent in primary APS patients, irrespective of initial presentation.
- Obstetric morbidity is a key concern in OAPS.
- Heart valve disease and ANA positivity are potential risk factors for thrombosis in OAPS patients.
Abstract:
Introduction: Primary obstetric antiphospholipid syndrome (OAPS) is defined by specific morbidities and/or losses of pregnancy in the presence of persistent antiphospholipid antibodies (aPL). This variant of APS is usually treated during pregnancy and the post-partum period. Data on occurrence of thrombotic event during long term follow-up of OAPS patients is limited. Methods: A multi-centre retrospectively cohort of female patients with primary APS (pAPS) was assembled during 2004-2019. Patients were grouped according to disease presentation as pure OAPS or thrombotic APS (tAPS) for those presenting with thrombosis. Clinical and serological data were compared between groups. Results: Of 219 pAPS female patients 67 (30.6%) were diagnosed with OAPS and 152 (69.4%) with tAPS. During >10 years of follow-up 24/67 (35.8%) OAPS and 71/152 (50%) tAPS suffered a new thrombotic event (p = 0.06), while obstetric morbidity was more likely in the OAPS group (31.3 vs. 10.5%, p < 0.001) respectively. Among patients with OAPS at presentation heart valve disease and the presence of ANA were related to thrombosis following diagnosis (25 vs. 4.7%, p = 0.02; and 45.8 vs. 20.8%, p = 0.04 respectively). Conclusion: Thrombotic event following diagnosis were common among female patients with pAPS regardless of disease presentation. Heart valve disease and ANA positivity may be risk factors for thrombosis during follow-up of patients presenting with pure OAPS.
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