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
Open accessAbstract
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.
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A history of thrombotic APS is associated with increased risk for future thrombotic or obstetric events.
“Because a history of thrombotic APS is associated with increased risk for future thrombotic or obstetric events,65 treatment with LDA and heparin at therapeutic dosage during pregnancy is recommended.”
From EULAR recommendations for the management of antiphospholipid syndrome in adults (2019) · cites this paper as [65]
The Results state that women whose thrombosis preceded obstetric APS were excluded from the analysis. The Discussion (Main Findings) instead examines first thrombosis after pregnancy morbidity; our copy does not assess whether a history of thrombotic APS increases the risk of later thrombotic or obstetric events. (LLM, conf=0.78)
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- Authors
- de Jesús, G., Sciascia, S., Andrade, D., Barbhaiya, M., Tektonidou, M., Banzato, A., Pengo, V, Ji, L., Meroni, P., Ugarte, A., Cohen, H., Branch, D., Andreoli, L., Belmont, H., Fortin, P., Petri, M., Rodriguez, E., Cervera, R., Knight, J., Atsumi, T., Willis, R., Nascimento, I., Rosa, R., Erkan, D., Levy, R., & ACTION, A.
- Affiliations
- Department of Obstetrics Universidade do Estado do Rio de Janeiro Rio de Janeiro Brazil
- University of Turin (IT)
- Universidade de São Paulo (BR)
- Hospital for Special Surgery (US)
- National and Kapodistrian University of Athens (GR)
- University of Padua (IT)
- Peking University (CN)
- Department of Rheumatology University of Milan Milan Italy
- Hospital de Cruces (ES)
- University College London (GB)
- Intermountain Healthcare (US)
- Rheumatology and Clinical Immunology Department of Clinical and Experimental Sciences University of Brescia Brescia Italy
- Division of Rheumatology NYU School of Medicine New York NY USA
- Division of Rheumatology Centre Hospitalier de l'Université Laval Québec QC Canada
- Johns Hopkins University (US)
- Rheumatology Department Hospital 12 de Octubre Madrid Spain
- Hospital Clínic de Barcelona (ES)
- University of Michigan (US)
- Hokkaido University (JP)
- The University of Texas Medical Branch at Galveston (US)
- Departament of Rheumatology Universidade de São Paulo São Paulo Brazil
- Department of Rheumatology Universidade do Estado do Rio de Janeiro Rio de Janeiro Brazil
- ORCID
- Venue
- BJOG: An International Journal of Obstetrics & Gynaecology
- Publisher
- Wiley
- Published
- 2018-10-24
- Volume
- 126
- Issue
- 5
- Pages
- 656-661
- ISSN
- 0306-5456 (ISSN-L)
- 1470-0328
- 1471-0528
- PMC
- PMC7382947
- OpenAlex
- W2890833593
- Cited by
- 45
- References
- 15
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 4 · 2023: 3 · 2022: 6 · 2021: 8 · 2020: 8 · 2019: 8
- FWCI
- 5.11
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- BJOG An International Journal of Obstetrics & Gynaecology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion)
- Padua Research Archive (University of Padova) (submittedVersion)
- Funders
- National Institutes of Health (UL1TR002384)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR069572)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Life Sciences › Immunology and Microbiology › Immunology › Reproductive System and Pregnancy
- Keywords
- obstetric antiphospholipid syndrome, thrombosis, antiphospholipid antibodies, risk factors, pregnancy morbidity, risk stratification, cardiovascular risk factors, valvular heart disease, superficial thrombophlebitis, postpartum thrombosis
- MeSH terms
- Adult, Clinical Trials as Topic, Female, Humans, Pregnancy, Pregnancy Complications, Cardiovascular, Registries, Retrospective Studies, Risk Factors, Thrombosis, Databases, Factual, Antiphospholipid Syndrome, Antibodies, Antiphospholipid
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