Morbidity and mortality in the antiphospholipid syndrome during a 10-year period: a multicentre prospective study of 1000 patients

Cervera, Ricard; Khamashta, Munther A.; Shoenfeld, Yehuda; Camps, María Teresa; Jacobsen, Søren; Kiss, Emese; Zeher, Margit; Tincani, Anǵela; Kontopoulou-Griva, I.; Galeazzi, Mauro; Bellisai, Francesca; Meroni, Pier Luigi; Derksen, R. H. W. M.; Groot, P. G. De; Gromnica‐Ihle, Erika; Baleva, M; Mosca, Marta; Bombardieri, Stefano; Houssiau, Frédéric; Gris, Jean‐Christophe; Quéré, Isabelle; Hachulla, É.; Vasconcelos, Carlos; Roch, B.; Fernández‐Nebro, Antonio; Piette, Jean‐Charles; Espinosa, Gerard; Bucciarelli, Silvia; Pisoni, Cecilia; Bertolaccini, Maria Laura; Boffa, MC; Hughes, G. R. V.

doi:10.1136/annrheumdis-2013-204838

Cited by 694 publications

(573 citation statements)

References 35 publications

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“…This holds true for treatment of thrombotic APS, where the current mainstay is heparin followed by VKA such as warfarin [6]. Limitations of VKA uses include a narrow therapeutic window, need for repeated monitoring, many food and drug interactions and high variability of response with the need for repeated dose titration.…”

Section: Is Long-term Anti-coagulation An Integral Part Of Treatment mentioning

confidence: 99%

“…93 (9.3%) patients died and the most frequent causes of death were severe thrombosis (36.5%) and infections (26.9%). Nine (0.9%) cases of CAPS occurred and 5 (55.6%) of them died [6].…”

Section: Anti-phospholipid Antibodies and Thrombosis In Immune Disordersmentioning

confidence: 99%

“…Among 1000 patients from 13 European countries with APS who were followed up for 10 years, 53.1% of the patients had primary APS, 36.2% had APS associated with SLE and 10.7% APS associated with other diseases [6].…”

Section: Anti-phospholipid Antibodies and Thrombosis In Immune Disordersmentioning

confidence: 99%

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Oral Direct Anticoagulants in Thrombosis Management in Anti-Phospholipid Syndrome: Unanswered Questions

G¹

2015

J Hematol Thrombo Dis

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Anti-phospholipid syndrome comprises a broad spectrum of manifestations with thrombotic events as a serious issue. The current mainstay of treatment for thrombotic anti-phospholipid syndrome is heparin followed by long-term anticoagulation with vitamin K antagonists. Vitamin K antagonists' management in this group of patients is frequently cumbersome, requires close monitoring and may affect patient's quality of life. There is also a high recurrence rate in high risk patients. The introduction of the oral direct inhibitors of coagulation for the management for thromboembolism is currently established for several indications.These agents are fixed dose with predictable anticoagulant effect and do not interact with dietary constituents and have few drug interactions. They have a rapid onset of action and don't routinely require monitoring. The shortcomings of vitamin K antagonists and the advantages of the oral direct inhibitors encouraged their trial in antiphospholipid syndrome. Case series of their use paved the road for designing clinical trials aiming to study their potential role in this important group of patients.In this article, we reviewed the literature regarding the current state of oral direct anticoagulants in thrombosis management in general, cited the case series results and presented the ongoing clinical trials that are currently underway. We also raise some practical points relevant to their application in specific situations. It is premature to pass comments on their applicability, but the seriousness of the issue

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Section: Is Long-term Anti-coagulation An Integral Part Of Treatment mentioning

confidence: 99%

“…93 (9.3%) patients died and the most frequent causes of death were severe thrombosis (36.5%) and infections (26.9%). Nine (0.9%) cases of CAPS occurred and 5 (55.6%) of them died [6].…”

Section: Anti-phospholipid Antibodies and Thrombosis In Immune Disordersmentioning

confidence: 99%

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Oral Direct Anticoagulants in Thrombosis Management in Anti-Phospholipid Syndrome: Unanswered Questions

G¹

2015

J Hematol Thrombo Dis

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“…In contrast, aPL have been reported to be more common in women with stillbirths, recurrent miscarriages, pre-eclampsia and intrauterine growth restriction (IUGR). Approximately 7-25% of unexplained recurrent miscarriage may be due to the presence of aPL (Drakeley et al 1998) along with 3.8% of stillbirths and 13.7% of IUGR (Silver et al 2013, Cervera et al 2015. The reported occurrence of aPL in pre-eclampsia is highly variable, ranging from 11% to 61% (Branch et al 1989, Yasuda et al 1995, Katano et al 1996; however, one group has shown that aPL are one of the strongest maternal risk factors for developing pre-eclampsia, increasing a woman's risk approximately ten-fold (Duckitt & Harrington 2005).…”

Section: Apl and Obstetric Diseasesmentioning

confidence: 99%

The role of anti-phospholipid antibodies in autoimmune reproductive failure

2016

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Anti-phospholipid antibodies (aPL) are autoantibodies that are associated with thrombosis and a range of pregnancy complications including recurrent pregnancy loss and pre-eclampsia. The three clinically relevant, well-characterized aPL are anti-cardiolipin antibodies, lupus anticoagulant and anti-beta-2-glycoprotein I (β 2 GPI) antibodies. aPL do not bind directly to phospholipids but instead bind to a plasma-binding 'cofactor'. The most extensively studied cofactor is β 2 GPI, whose role in pregnancy is not fully elucidated. Although the pathogenicity of aPL in recurrent pregnancy loss is well established in humans and animal models, the association of aPL with infertility does not appear to be causative. aPL may exert their detrimental effects during pregnancy by directly binding trophoblast cells of the placenta, altering trophoblast signalling, proliferation, invasion and secretion of hormones and cytokines, and by increasing apoptosis. Heparin is commonly used to treat pregnant women with aPL; however, as thrombotic events do not occur in the placentae of all women with aPL, it may exert a protective effect by preventing the binding of aPL to β 2 GPI or by acting through non-thrombotic pathways. The aim of this review is to present evidence summarizing the current understanding of this field.Reproduction (2016) 151 R79-R90

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“…The presence of these antibodies in pregnant women raises the possibility of obstetric and thrombotic complications [4]. The causal relationship between antiphospholipid antibodies and preeclampsia has not yet been proven [5].…”

mentioning

confidence: 99%

Antiphospholipid antibodies in pregnant women with preeclampsia: a case control study

Kadhim¹

2017

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Preeclampsia is a major cause of maternal morbidity and mortality, complicating 3-14% of all pregnancies. Pregnancy complicated by antiphospholipid antibodies and preeclampsia in pregnancy share several common characteristics, which suggest that the association between the two conditions is more than coincidental. To assess the level of antiphospholipid antibodies in normal pregnancy and in pregnancy complicated by preeclampsia a case control prospective study carried out in Department of Obstetrics and Gynecology/Baghdad Teaching Hospital/ Medical City/ from January 2012 to January 2013. Seventy-two pregnant women were enrolled into this study, 48 with preeclampsia (mild and severe), and 24 women without hypertension as a control group. Their age ranges from (16-42 years) and gestational age between (24-40 weeks). Antiphospholipid antibodies APLAB (IgG and IgM) and anticardiolipin antibodies ACLAB (IgG and IgM) levels were measured by ELISA (enzyme. linked ImmunoSorbent Assay) in all participates. The study showed elevation of ACLAB IgM in preeclampsia group with mean ±SD of (21.93±16.12), (8.22±1.75) for severe and mild preeclampsia respectively while in the control group it was (6.62± 2.8). This was highly significant in severe preeclampsia when compared to mild and control group. We conclude that there is significantly elevated level of ACLAB IgM in severe preeclampsia when compared to normal pregnancy.

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Morbidity and mortality in the antiphospholipid syndrome during a 10-year period: a multicentre prospective study of 1000 patients

Cited by 694 publications

References 35 publications

Oral Direct Anticoagulants in Thrombosis Management in Anti-Phospholipid Syndrome: Unanswered Questions

Oral Direct Anticoagulants in Thrombosis Management in Anti-Phospholipid Syndrome: Unanswered Questions

The role of anti-phospholipid antibodies in autoimmune reproductive failure

Antiphospholipid antibodies in pregnant women with preeclampsia: a case control study

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