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Thromb Haemost 2014; 112(04): 727-735
DOI: 10.1160/TH14-03-0191
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

Treatment strategies and pregnancy outcomes in antiphospholipid syndrome patients with thrombosis and triple antiphospholipid positivity

A European multicentre retrospective study
Amelia Ruffatti
1   Rheumatology Unit, Department of Medicine, University Hospital, Padua, Italy
,
Elisa Salvan
1   Rheumatology Unit, Department of Medicine, University Hospital, Padua, Italy
,
Teresa Del Ross
1   Rheumatology Unit, Department of Medicine, University Hospital, Padua, Italy
,
Maria Gerosa
2   Department of Clinical Sciences and Community Health, University of Milan, Istituto G. Pini and IRCCS Istituto Auxologico Italiano, Milan, Italy
,
Laura Andreoli
3   Rheumatology and Clinical Immunology Units, University Hospital, Brescia, Italy
,
Aldo Maina
4   Department of Internal Medicine, University Hospital, Turin, Italy
,
Jaume Alijotas-Reig
5   Systemic Autoimmune Diseases Unit, Department of Internal Medicine-1, Vall d’Hebron University Hospital, Barcelona, Spain
,
Sara De Carolis
6   Department of Obstetrics and Gynecology, Catholic University of Sacred Hearth, Rome, Italy
,
Arsene Mekinian
7   Service de Médecine Interne, Université Paris 13, AP-HP, Hôpital Jean Verdier, Bondy, France
,
Maria Tiziana Bertero
8   Clinical Immunology and Allergology Units, Mauriziano Hospital, Turin, Italy
,
Valentina Canti
9   San Raffaele Scientific Institute, University of Milan, Milan, Italy
,
Antonio Brucato
10   Department of Internal Medicine, Hospital of Bergamo, Bergamo, Italy
,
Katarina Bremme
11   Department of Women´s and Children´s Health, Division of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden
,
Véronique Ramoni
12   Rheumatology Unit, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy
,
Marta Mosca
13   Rheumatology Unit, University of Pisa, Pisa, Italy
,
Emma Di Poi
14   Division of Rheumatology, DPMSC, School of Medicine, University of Udine, Udine, Italy
,
Paola Caramaschi
15   Rheumatology Unit, AOUI, Verona, Italy
,
Mauro Galeazzi
16   Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
,
Angela Tincani
3   Rheumatology and Clinical Immunology Units, University Hospital, Brescia, Italy
,
Pier Luigi Meroni
2   Department of Clinical Sciences and Community Health, University of Milan, Istituto G. Pini and IRCCS Istituto Auxologico Italiano, Milan, Italy
› Author Affiliations
Further Information

Publication History

Received: 01 March 2014

Accepted after major revision: 08 May 2014

Publication Date:
04 December 2017 (online)

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Summary

Previous thrombosis, diagnosis of systemic lupus erythematosus (SLE) and triple antiphospholipid (aPL) antibody positivity have recently been found to be independent factors associated to pregnancy failure during conventional therapy in women with antiphospholipid syndrome (APS). This study aimed to assess the effect of various treatment strategies on pregnancy outcomes in women with APS and the risk factors for pregnancy failure. One hundred ninety-six pregnancies of 156 patients diagnosed with APS were analysed: 118 (60.2%) of these had previous thrombosis, 81 (41.3%) were diagnosed with SLE, and 107 (54.6%) had triple aPL positivity. One hundred seventy-five (89.3%) were treated with conventional therapies (low-dose aspirin [LDA] or prophylactic doses of heparin + LDA or therapeutic doses of heparin + LDA), while 21 (10.7%) were prescribed other treatments in addition to conventional therapy. The pregnancies were classified into seven risk profiles depending on the patients’ risk factors – thrombosis, SLE, and triple aPL positivity – and their single, double or triple combinations. It was possible to find significant difference in outcomes correlated to treatments only in the thrombosis plus triple aPL positivity subset, and logistic regression analysis showed that additional treatments were the only independent factor associated to a favourable pregnancy outcome (odds ratio=9.7, 95% confidence interval= 1.1–88.9, p-value<0.05). On the basis of this retrospective study, we found that APS pregnant patients with thrombosis and triple aPL positivity treated with additional therapy had a significant higher livebirth rate with respect to those receiving conventional therapy alone.

Keywords

Antiphospholipid antibodies - antiphospholipid syndrome - pregnancy - risk factors - treatment
 

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