The first thrombotic event in purely obstetric antiphospholipid syndrome patients and in antiphospholipid antibody carri
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MATERNAL-FETAL MEDICINE
The first thrombotic event in purely obstetric antiphospholipid syndrome patients and in antiphospholipid antibody carriers: comparison of incidence and characteristics Marta Tonello1 · Antonia Calligaro1 · Maria Favaro1 · Teresa Del Ross1 · Paola Veronese2 · Elisa Salvan3 · Maria Teresa Gervasi2 · Amelia Ruffatti1 Received: 9 May 2020 / Accepted: 24 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose The long-term risk of thrombosis after pregnancy in women with purely obstetric antiphospholipid syndrome (OAPS) is not well defined. The current study’s primary outcome was to evaluate the incidence and characteristics of the first thrombotic event in OAPS, identifying the risk factors for thrombosis in OAPS was its secondary one. Methods Patients with purely OAPS were consecutively enrolled between September 1999 and September 2019. Subjects without a history of pregnancy morbidity or thrombosis but with persistent positivity for one or more antiphospholipid antibodies (aPL carriers) made up the control group. The study groups included 94 OAPS patients and 124 aPL carriers who were matched for clinical and laboratory parameters. Results An event rate of 0.49/100 patient years was registered in OAPS patients during a mean follow-up of 8.7 years ± 5.5 SD. Kaplan–Meier survival analysis revealed that the cumulative incidence of thromboembolic events was not significantly different in OAPS patients vs aPL carriers. Arterial thrombosis and cerebrovascular events were the more frequent types of vascular involvement in the two groups. As far as risk factors for thrombosis were concerned, the presence of lupus anticoagulant significantly prevailed in both thrombotic OAPS patients and thrombotic aPL carriers with respect to purely OAPS patients and aPL carriers who did not develop thrombosis (p = 0.01 and p = 0.00, respectively). Conclusion Just as for aPL carriers, closer monitoring and possibly, a pharmacological prophylaxis should be reserved for OAPS patients at highest risk of developing the first thrombotic event. Keywords Antiphospholipid syndrome · Pregnancy · Antiphospholipid antibodies · Carriers · Thrombosis
Introduction The clinical criteria for classification of obstetric involvement of antiphospholipid syndrome (APS) include one or more unexplained fetal deaths occurring at or beyond the 10th week of gestation and/or one or more premature births before the 34th week of gestation because of eclampsia or * Amelia Ruffatti [email protected] 1
Rheumatology Unit, Department of Medicine, University Hospital of Padua, Padua, Italy
2
Obstetrics and Gynecology Unit, Department of Woman’s and Child’s Health, University Hospital of Padua, Padua, Italy
3
General Department, University of Padua, Padua, Italy
severe preeclampsia or recognized features of placental insufficiency and/or three or more unexplained consecutive miscarriages before the 10th week of gestation [1]. In addition, lupus anticoagulant (LAC), and/or IgG/IgM antica
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