Obstetric antiphospholipid syndrome and long term arterial thrombosis risk

Abstract

Antiphospholipid syndrome (APS) is classified as the association of a thrombotic event and/or obstetric morbidity in patients persistently positive for antiphospholipid antibodies and/or lupus anticoagulant. To evaluate the incidence of subsequent thrombosis among women diagnosed with purely obstetric APS. We retrospectively reviewed and collected demographic and clinical data from the computerized charts of all patients with obstetric APS, from 1992 to 2017. Eligibility criteria included all women diagnosed with APS, according to the 2006 revised criteria, for whom the clinical manifestations were purely obstetric. The primary endpoint was the occurrence of subsequent thromboembolic events, following diagnosis of obstetric APS. The study included 115 women diagnosed with obstetric APS. During the study's follow up period, 12 (10.4%) women developed thrombosis. Of the 12 women who developed thrombosis, 9 (75%) of the thrombotic events were arterial. The site of arterial thrombosis was cerebral in all cases. Venous thrombosis occurred in 3 (25%) women, including one in each of the following sites-pulmonary embolism, ovarian vein thrombosis and proximal leg deep vein thrombosis. Our data suggests that women with obstetric APS are at risk for subsequent long-term thrombosis, especially arterial cerebral events. We did not identify any clinical or laboratory unique features among women with obstetric APS who will eventually develop thrombosis.

The European Registry on Obstetric Antiphospholipid Syndrome (EUROAPS): A survey of 1000 consecutive cases

“…Case-tailored management was found probably because patients with less thrombotic events observed came from these specialized centers. We only found 31 cases (3.1%) in which thrombotic phenomena occurred, in contrast to what was published by Drozidnsky et al, where the thrombosis rate reached 12% [31]. In any case and contrary to what was classically thought, it seems that venous and/or arterial thromboses are not frequent complications among the OAPS patients.…”

Microparticles: An Alternative Explanation to the Behavior of Vascular Antiphospholipid Syndrome

“…This idea is supported by two types of in vitro evidence, 12,13,33,34 and epidemiological observation that is uncommon for thrombotic manifestations to be present in patients with pregnancy morbidity. 10,35 These findings suggest that gestational manifestations cannot be explained by placenta infarction, as previously proposed, 36 and instead it can be described as a complement-dependent inflammatory injury. 37,38 Vascular APS and obstetric APS do not seemingly share pathological mechanisms and, thus, the syndrome manifests itself in two different ways (►Table 1).…”

16th International Congress on Antiphospholipid Antibodies Task Force Report on Obstetric Antiphospholipid Syndrome

“…108 Other authors have also reported an increased risk for long-term thrombosis after obstetric APS, 109 specially arterial cerebral events. 110 Nonetheless, most of publications could not identify clinical or laboratorial features that would indicate patients more likely to develop thrombosis. 110…”

“…110 Nonetheless, most of publications could not identify clinical or laboratorial features that would indicate patients more likely to develop thrombosis. 110…”