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Cited by 29Systemic Lupus Erythematosus ResearchReproductive System and PregnancyPregnancy and preeclampsia studies

High risk of adverse pregnancy outcomes in women with a persistent lupus anticoagulant

Open access
Gebhart, Johanna, Posch, Florian, Koder, Silvia, Quehenberger, Peter, Perkmann, Thomas, Kuessel, Lorenz, Ay, Cihan, Pabinger, Ingrid·2019·Blood Advances
DOI 10.1182/bloodadvances.2018026948PMC PMC6418496
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Abstract

Lupus anticoagulant (LA) has been associated with pregnancy complications and pregnancy loss. Identification of predictive factors could aid in deciding on therapeutic management. To identify risk factors for adverse pregnancy outcomes in high-risk women with persistently positive LA, we prospectively followed 82 women of childbearing age, of whom 23 had 40 pregnancies within the Vienna Lupus Anticoagulant and Thrombosis Study. Pregnancy complications occurred in 28/40 (70%) pregnancies, including 22 (55%) spontaneous abortions (<10th week of gestation [WOG]: n = 12, 10th to 24th WOG: n = 10) and 6 deliveries <34th WOG (15%, 3 due to severe preeclampsia/HELLP [hemolysis, elevated liver enzymes, and a low platelet count] syndrome, 3 due to placental insufficiency). One abortion was followed by catastrophic antiphospholipid syndrome. Neither a history of pregnancy complications nor of thrombosis, or prepregnancy antiphospholipid antibody levels were associated with adverse pregnancy outcomes. In logistic regression analysis, higher age was associated with a lower risk of adverse pregnancy outcome (per 5 years’ increase: odds ratio [OR] = 0.41, 95% confidence interval [CI]: 0.19-0.87), a high Rosner index (index of circulating anticoagulant) predicted an increased risk (OR = 4.51, 95% CI: 1.08-18.93). Live birth rate was 15/28 (54%) in women on the combination of low-molecular-weight heparin and low-dose aspirin and 3/12 (25%) in those with no treatment or a single agent. We conclude that the risk of severe, even life-threatening pregnancy complications and adverse pregnancy outcomes is very high in women with persistent LA. A high Rosner index indicates an increased risk. Improved treatment options for women with persistently positive LA are urgently needed.

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  • aCL are generally regarded as less symptomatic than LA or aB2GPI.

    “which implies that aCL are generally regarded as less symptomatic than their conventional aPL counterparts.”

    From Single or triple positivity for antiphospholipid antibodies in “carriers” or symptomatic patients: Untangling the knot (2021) · cites this paper as [6]

    The Discussion (page unavailable) calls LA a major risk factor for pregnancy complications, which lends limited support to distinguishing it from aCL. But the Results say that neither aCL nor aβ2GPI antibody levels appeared predictive in this LA-positive cohort, and the Discussion cautions against generalizing to patients with isolated aCL or aβ2GPI. The paper therefore does not support the broader claim that aCL is generally less symptomatic than both. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • In the literature, among aPL, isolated LA and aB2GPI are generally found to be associated with higher thrombotic risk than aCL.

    “In the literature, 5-­ 8 among the aPL, isolated LA and aB2GPI are generally found to be associated with higher thrombotic risk than aCL.”

    From Single or triple positivity for antiphospholipid antibodies in “carriers” or symptomatic patients: Untangling the knot (2021) · cites this paper as [6]

    The Introduction (page unavailable) says antiphospholipid antibodies are associated with a prothrombotic state, but does not compare the thrombotic risks of isolated LA, anti-β2GPI, and aCL. The Discussion (page unavailable) concerns pregnancy outcomes in LA-positive women and says its findings cannot be generalized to isolated aCL- or anti-β2GPI-positive patients. Searches for the antibody-specific thrombotic-risk comparison found no passage addressing it. (LLM, conf=0.75)

    Experimental — accuracy not yet measured

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Cites

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Research works printed but not linked: 29

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Cited by

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Authors
Gebhart, J., Posch, F., Koder, S., Quehenberger, P., Perkmann, T., Kuessel, L., Ay, C., & Pabinger, I.
Affiliations
  • Medical University of Vienna (AT)
  • Medical University of Graz (AT)
  • Division of Medical and Chemical Laboratory Diagnostics, Department of Laboratory Medicine, and
ORCID
Venue
Blood Advances
Publisher
American Society of Hematology
Published
2019-03-05
Volume
3
Issue
5
Pages
769-776
ISSN
  • 2473-9529 (ISSN-L)
  • 2473-9537
DOI
10.1182/bloodadvances.2018026948
PMC
PMC6418496
OpenAlex
W2918224126
Cited by
29
References
9
Citations by year
2026: 1 · 2025: 4 · 2024: 5 · 2023: 6 · 2022: 6 · 2021: 4 · 2020: 2 · 2019: 1
FWCI
2.47
Type
journal article
Language
en
Open access
Licence
cc-by-nc-nd
Locations
  • Blood Advances (publishedVersion, cc-by-nc-nd)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Austrian Science Fund (SFB‐54)
  • Universität Wien
  • Medizinische Universität Wien
Topics
  • Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
  • Life Sciences › Immunology and Microbiology › Immunology › Reproductive System and Pregnancy
  • Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
Keywords
lupus anticoagulant, adverse pregnancy outcomes, miscarriage, preeclampsia, HELLP syndrome, placental insufficiency, antiphospholipid syndrome, low molecular weight heparin, low-dose aspirin, live birth rate, maternal age, pregnancy complications
MeSH terms
Adult, Female, Humans, Pregnancy, Pregnancy Complications, Pregnancy Outcome, Prognosis, Prospective Studies, Risk Factors, Lupus Coagulation Inhibitor, Young Adult

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