Clinical and therapeutic value of the adjusted Global Antiphospholipid Syndrome Score in primary obstetric antiphospholipid syndrome

Abstract

Objectives (1) To assess the clinical utility of the adjusted global antiphospholipid syndrome score (aGAPSS) to predict new obstetric events during follow-up in primary obstetric antiphospholipid syndrome (POAPS) patients under standard-of-care treatment (SC) based on the use of low-dose aspirin (LDA) + heparin and (2) to study the risk of a first thrombotic event and to evaluate whether stratification according to this score could help to identify POAPS patients who would benefit from long-term thromboprophylaxis. Methods This is a retrospective, multicentre study. 169 women with POAPS were evaluated for the presence of a new obstetric event and/or a first thrombotic event during follow-up [time period: 2008–2020, median: 7 years (6–12 years)]. The outcomes of 107 pregnancies from these POAPS patients with SC were studied to evaluate relapses. Simple and multivariable logistic regression analyses were performed. Results Regarding obstetric morbidity, only triple positivity for antiphospholipid antibodies (aPLs) [OR = 8.462 (95% CI: 2.732–26.210); p < 0.0001] was found to be a strong risk factor independently associated with treatment failure. On the other hand, triple positivity for aPLs [OR=10.44 (95% CI: 2.161–50.469), p = 0.004] and an aGAPSS ≥7 [OR = 1.621 (95% CI: 1.198–2.193), p = 0.002] were independent risk factors associated with a first thrombotic event. LDA was marginally associated with a decrease in the risk of thrombosis only in patients with aGAPSS ≥ 7 ( p = 0.048). Conclusion aGAPSS appears to be useful in predicting the occurrence of a first thrombotic event in POAPS patients, and these stratification of patients could be helpful in selecting patients who would benefit from thromboprophylaxis with LDA.

Clinical phenotype, treatment strategy and pregnancy outcome of non‐criteria obstetric antiphospholipid syndrome

“…The aPL profiles are defined as low-or high-risk aPL by EULAR, 18 however, in-depth studies are lacking on whether pregnancy outcomes correlate with the presence of different aPL antibodies, antibody titers, and isotypes. 38 We found a high incidence of GDM in several groups, and it is unclear how APS correlates with the incidence of GDM, considering the use of GC and its ability to affect impaired fasting glucose, which may explain the high incidence of GDM. For patients in subgroup C and subgroup L, treatment should also focus on complications respectively, for a higher prevalence of pregnancy loss in early pregnancy in subgroup L (24.62% vs. 14.55% in subgroup C, p = .002), and a higher prevalence of obstetrics complications related to placental insufficiency in 2nd-3rd trimester in subgroup C (12.73% vs. 7.70% in subgroup L, p = .360), details in Table 6.…”

“…There were significant differences in antibody titers between the two subgroups of NC‐OAPS, as shown in Table 5. The aPL profiles are defined as low‐ or high‐risk aPL by EULAR, 18 however, in‐depth studies are lacking on whether pregnancy outcomes correlate with the presence of different aPL antibodies, antibody titers, and isotypes 38 . We found a high incidence of GDM in several groups, and it is unclear how APS correlates with the incidence of GDM, considering the use of GC and its ability to affect impaired fasting glucose, which may explain the high incidence of GDM.…”

Association of XIST/miRNA155/Gab2/TAK1 cascade with the pathogenesis of anti-phospholipid syndrome and its effect on cell adhesion molecules and inflammatory mediators

“…APS can develop as a primary disease or secondary to another disease, such as systemic lupus erythematosus (SLE) 2 , 3 . Although APS antibodies predispose to thrombotic events and obstetrical complications, also other aspects may play a part such as environmental factors, inflammatory factors, or other non-immunological pro-coagulant mediators 4 .…”