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Factors Associated with First Thrombosis in Patients Presenting with Obstetric Antiphospholipid Syndrome in APS Alliance For Clinical Trials & International Networking (APS ACTION) Clinical Database And Repository: a retrospective study

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de Jesús GR1, Sciascia S2, Andrade D3, Nascimento IS3, Rosa R3, Barbhaiya M4, Tektonidou M5, Banzato A6, Pengo V6, Ji L7, Meroni PL8, Ugarte A9, Cohen H10, Branch DW11, Andreoli L12, Belmont HM13, Fortin PR14, Petri M15, Rodriguez E16, Cervera R17, Knight JS18, Atsumi T19, Willis R20, Erkan D4, Levy RA21,22; APS ACTION. BJOG. 2018 Sep 17. doi: 10.1111/1471-0528.15469. [Epub ahead of print]


OBJECTIVE: To evaluate subsequent rate of thrombosis among obstetric antiphospholipid syndrome (Ob-APS) women in a multicenter database of antiphospholipid antibody (aPL)-positive patients; and clinical utility of 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: APS Alliance For Clinical Trials & International Networking (APS ACTION) Clinical Database And Repository.

POPULATION: Women with Ob-APS.

METHODS: Comparison of clinical and laboratory characteristics; measurement of aGAPSS of Ob-APS women with or without thrombosis after initial pregnancy morbidity (PM).

MAIN OUTCOME MEASURES: Risk factors for thrombosis, aGAPSS.

RESULTS: Of 550 patients, 126 had Ob-APS; 74/126 (59%) presented thrombosis, and 47 (63%) of them developed thrombosis after initial PM, in a mean time of 7.6 ± 8.2 years (4.9/100 patient years). Younger age 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 higher aGAPSS compared to those with Ob-APS alone ([median 11.5 [4-16] vs 9 [4-13], P = 0.0089]).

CONCLUSION: Based on retrospective analysis of our multicenter aPL database, 63% of Ob-APS women developed thrombosis after initial obstetric morbidity; additional thrombosis risk factors, selected clinical manifestations, and high-risk aPL profile increased risk. Women with subsequent thrombosis after Ob-APS had higher aGAPSS score at registry entry. We believe that aGAPSS is a valid tool to improve risk stratification in aPL-positive women. There was no funding for this study.