Predictive value of the adjusted Global Anti-Phospholipid Syndrome Score on clinical recurrence in APS patients: a longitudinal study.

OBJECTIVE: To assess the effect of the average adjusted global APS score (aGAPSS) over time on recurrence of clinical manifestations in APS patients through a retrospective longitudinal study. MATERIAL AND METHODS: The study included 200 patients with APS. The aGAPSS was calculated for each patient at baseline and on a yearly basis for either up to 6 years (minimum 3 years) or just before the clinical event in patients who experienced clinical recurrence. The mean score per patient was computed. In patients under vitamin K antagonists (VKA) the percentage of time spent within the therapeutic range (TTR) was calculated. Cox regression analysis was performed to determine the cut-off value of the aGAPSS with the strongest association with clinical recurrence. RESULTS: Higher average aGAPSS values were found in patients who experienced clinical recurrence in comparison to patients who did not [8.81 (95% CI 7.53, 10.08) vs 6.38 (95% CI 5.64, 7.12), P = 0.001], patients with thrombotic recurrence compared with patients with obstetric recurrence [9.48 (95% CI 8.14, 10.82) vs 4.25 (95% CI 0.85, 7.65), P = 0.006] and patients with arterial thrombosis compared with patients with venous thrombosis [10.66 (S.D. 5.48) vs 6.63 (S.D. 4.42), P = 0.01]. aGAPSS values >13 points were associated with the highest risk of recurrence in multivariate analysis [HR = 3.25 (95% CI 1.93, 5.45), P < 0.0001]. TTR was not statistically different between patients who had thrombosis recurrence and patients who had not. CONCLUSIONS: Our data support the role of periodic (annual) monitoring of the aGAPSS score in predicting clinical recurrence in patients with APS.

Persistence of antiphospholipid antibodies over time and its association with recurrence of clinical manifestations: A longitudinal study from a single centre.

PURPOSE: To analyze the antiphospholipid antibody (aPL) persistence over time in patients with antiphospholipid syndrome (APS) and its association with clinical recurrence and to identify predictors of aPL persistence over time. PATIENTS AND METHODS: 200 patients with a diagnosis of APS and at least three follow-up aPL determinations were included. Persistent aPL profile was defined as the presence of lupus anticoagulant (LAC) and/or IgG/IgM anticardiolipin (aCL) and/or IgG/IgM anti-ß2 glycoprotein-I (aß2GPI) (> 99th percentile) antibodies in at least 66% of follow-up measurements. Multilevel mixed-effect generalized linear models with logit link were used. RESULTS: 112 (56%) patients maintained persistent aPL profiles over time, while 88 (44%) were transient. Median follow-up time was 172.5 months. Follow-up time did not affect the odds of aPL persistence in multivariate analysis (p = 1.00). Baseline triple aPL positivity [OR 78 (95%CI 16.9-359.7, p < 0.001)] and double aPL positivity [OR = 7.6 (95%CI 3.7-15.7, p < 0.001)] correlated with persistent aPLs over time, while isolated LAC [OR = 0.26 (95% CI 0.08-0.49, p = 0.002)] or isolated IgG/IgM aCL [OR = 0.20 (95% CI 0.11-0.59, p = 0.004)] positivity, were predictors of transient aPL profile. Patients with persistent aPLs had higher rate of clinical recurrence in comparison to patients with transient aPLs [OR = 2.48 (95%CI 1.34-4.58, p = 0.003)]. CONCLUSIONS: More than half of patients with baseline medium-high titer aPL positivity had persistent positive aPLs over time. Patients with persistent aPLs were more prone to present recurrence of clinical manifestations. Multiple aPL positivity increased the odds of a persistent aPL profile over time, while isolated LAC and aCL positivity decreased it.

Manejo de las complicaciones vasculares gestacionales y trombosis en la mujer / Management of gestational vascular complications and thrombosis in women

Objetivo: conocer la prevalencia de trombofilia en trombosis gestacional y complicaciones vasulares gestacionales en nuestro entorno y el manejo de las mismas. Material y métodos: estudio prospectivo y observacional en el que se incluyeron cuatro cohortes: trombosis, profilaxis de trombosis, complicaciones vasulares gestacionales, profilaxis de complicaciones vasulares gestacionales. Se registraron 1.032 episodios, de los cuales se incluyeron 994 en el análisis final. Resultados: la distribución de episodios fue: 5,5% trombosis, 30,2% profilaxis de trombosis, 35,7% complicaciones vasulares gestacionales y 24,9% profilaxis de complicaciones vasulares gestacionales. Las pérdidas gestacionales fueron la complicación más frecuente. Se realizó estudio de trombofilia en 82,6% de complicaciones vasulares gestacionales y 70,2% de trombosis. Los resultados fueron positivos en el 47% de trombosis y en 21% de complicaciones vasulares gestacionales. Los defectos más comunes en complicaciones vasulares gestacionales fueron la elevación del factor VIII, la presencia de anticuerpos antifosfolípidos y la mutación F12C46T en homocigosis. Se empleó tratamiento antitrombótico en el 85% de profilaxis de trombosis y en el 77% de profilaxis de complicaciones vasulares gestacionales. La tromboprofilaxis de complicaciones vasulares gestacionales no se relacionó con una mejora en el resultado de la gestación. Conclusiones: se realizaron estudios de trombofilia a la mayoría de las pacientes, con resultados diferentes en trombosis y complicaciones vasulares gestacionales. Se empleó tromboprofilaxis en más del 70% de las pacientes. La profilaxis farmacológica de complicaciones vasulares gestacionales no aportó beneficio significativo. Serían necesarios estudios futuros para confirmar nuestros resultados (AU)

Objective: The main objectives were to establish the prevalence of thrombophilia in pregnancy-related thrombosis and vascular placental complications and to evaluate the clinical management of these complications. Materials and methods: Multicenter, prospective and observational study. We analysed 4 patient cohorts: thrombosis, thrombosis prophylaxis, vascular placental complications, vascular placental complications prophylaxis. A total of 1032 episodes were registeredand 994 were included in the final analysis. Results: The distribution of the episodes was: 5.5% thrombosis, 30.2% thrombosis prophylaxis, 35.7% vascular placental complications and 24.9% vascular placental complications prophylaxis. Pregnancy loss was the most frequent complication registered. Thrombophilia studies were made in 82.6% patients in vascular placental complications cohort and in 70.2% of thrombosis patients. Positive results were obtained in 47% of patients in thrombosis group and in 21% of patients with vascular placental complications. In this group the most common defects found were high levels of FVIII, positive antiphospholipid antibodies and homocigosity for F12C46T polymorphism. Antithrombotic treatment was used in 85% of thrombosis prophylaxis episodes and in 77% of vascular placental complications prophylaxis episodes. Pharmacologic prophylaxis was not related with a better pregnancy outcome in vascular placental complications prophylaxis group. Conclusions: Thrombophilia studies were made to most patients in this registry. Results were different in patients with thrombosis and vascular placental complications. Most patients in vascular placental complications prophylaxis group with or without thrombophilia recieved LMWH +/- aspirin, but we did not find a benefit of these treatments. Further studies with more patients will be needed to confirm our findings (AU)