Clinical characteristics and prognosis of patients with isolated thrombotic vs. obstetric antiphospholipid syndrome: a prospective cohort study

Jiang, Hui; Wang, Chu-Han; Jiang, Nan; Li, Jing; Wu, Caimei; Wang, Qian; Li, Mengtao; Tian, Xinping; Zhao, Yan; Zeng, Xiaofeng

doi:10.1186/s13075-021-02515-w

Cited by 17 publications

(11 citation statements)

References 33 publications

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“…1,5,20,27 On the contrary, hyperhomocysteinemia and antiphospholipid antibodies are accepted as risk factors for AT. 20,[27][28][29][30] However, there were rarely studies that attempted to support this hypothesis. Some studies have shown the prevalence of AT in people with PC, PS, and ATIII deficiencies, as well as other studies that had provided data on PC, PS, and AT III deficiency in patients with AT.…”

Section: Discussionmentioning

confidence: 99%

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Deficiency of Natural Anticoagulants Involves in the Occurrence of Arterial Thrombosis

Nguyen,

Vu,

Nguyen

et al. 2023

Clin Med�Insights�Blood�Disord

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Background The role of natural anticoagulant deficiency in the development of arterial thrombosis (AT) is controversial. Objective Our objectives were to assess the deficiency of natural anticoagulants, including protein S (PS), protein C (PC), antithrombin III (AT III) and their involvement in the occurrence of AT. Design Retrospective cross-sectional study. Methods This study was conducted in 585 patients who were examined with PS, PC, and AT III tests. The activity of PC, PS (men, women), and ATIII under 70%, 75%, 60%, and 80% was recognized as a deficiency, respectively. Peripheral blood cell and coagulation tests were performed before starting treatment. Patients with previous AT, venous thromboembolism (VTE) or anticoagulant therapy were excluded. Results Patients without thrombosis were 222 (38%), patients with newly diagnosed VTE were 281 (48%), and patients with newly diagnosed AT were 82 (14%). The most common AT sites were in the lungs, brain, and lower extremities (31.2%, 20.8%, and 20.8%, respectively). Compared to the nonthrombosis group, the AT group had a lower PS activity (%) (82.77 ± 24.09 vs 91.31 ± 27.27), a higher fibrinogen (g/L) (4.25 ± 1.68 vs 3.74 ± 1.51), a higher D-dimer (mg/L FEU) (6.16 vs 1.95), and a higher neutrophil count (G/L) (8.57 vs 6.50) with P < .05. Compared to the VTE group, the AT group had higher hemoglobin (g/L) (135.95 ± 23.75 vs 129.02 ± 25.22) and a higher neutrophil count (G/L) (8.57 vs 7.28) ( P < .05). In the AT group, the frequencies of PC, PS, and AT III deficiency were 23.1%, 28%, and 17.1%, respectively. The AT group had a higher frequency of PS deficiency than the nonthrombosis group (28% vs 17.1%, P = .035). Patients with PS deficiency had a higher risk of AT compared to those without PS deficiency (OR = 1.888, 95% CI [1.041-3.422], P = .036). Conclusion PS deficiency may be considered a factor in increasing the risk of AT.

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Section: Discussionmentioning

confidence: 99%

“…1,5,20,27 On the contrary, hyperhomocysteinemia and antiphospholipid antibodies are accepted as risk factors for AT. 20,27–30…”

Section: Discussionmentioning

confidence: 99%

Deficiency of Natural Anticoagulants Involves in the Occurrence of Arterial Thrombosis

Nguyen,

Vu,

Nguyen

et al. 2023

Clin Med�Insights�Blood�Disord

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“…In regard to thrombosis following the diagnosis of OAPS the evidence is discordant between studies, as some suggest that the rate of thrombosis is low ( Alijotas-Reig et al, 2015 ; Jiang et al, 2021 ), while others documented a high risk despite preventive therapy ( Lefèvre et al, 2011 ; Drozdinsky et al, 2017 ). One such example is derived from The APS ACTION cohort in which the risk of thrombosis amounted to 60% among OAPS patient ( de Jesús et al, 2019 ).…”

Section: Discussionmentioning

confidence: 99%

Long Term Follow up of Patients With Primary Obstetric Antiphospholipid Syndrome

et al. 2022

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Introduction: Primary obstetric antiphospholipid syndrome (OAPS) is defined by specific morbidities and/or losses of pregnancy in the presence of persistent antiphospholipid antibodies (aPL). This variant of APS is usually treated during pregnancy and the post-partum period. Data on occurrence of thrombotic event during long term follow-up of OAPS patients is limited.Methods: A multi-centre retrospectively cohort of female patients with primary APS (pAPS) was assembled during 2004–2019. Patients were grouped according to disease presentation as pure OAPS or thrombotic APS (tAPS) for those presenting with thrombosis. Clinical and serological data were compared between groups.Results: Of 219 pAPS female patients 67 (30.6%) were diagnosed with OAPS and 152 (69.4%) with tAPS. During >10 years of follow-up 24/67 (35.8%) OAPS and 71/152 (50%) tAPS suffered a new thrombotic event (p = 0.06), while obstetric morbidity was more likely in the OAPS group (31.3 vs. 10.5%, p < 0.001) respectively. Among patients with OAPS at presentation heart valve disease and the presence of ANA were related to thrombosis following diagnosis (25 vs. 4.7%, p = 0.02; and 45.8 vs. 20.8%, p = 0.04 respectively).Conclusion: Thrombotic event following diagnosis were common among female patients with pAPS regardless of disease presentation. Heart valve disease and ANA positivity may be risk factors for thrombosis during follow-up of patients presenting with pure OAPS.

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“…Different situations are encountered which feed the heterogeneity of situations, fears and care: pregnant women with no known historical positivity for aPL Abs but new evidence of positive aPL Abs, women with a known asymptomatic chronic carriage of aPL Abs but no constituted APS, those with a previous diagnosis of pure thrombotic APS (tAPS), of pure obstetric APS (oAPS), or of thrombotic and oAPS (mixed APS). Despite generally similar autoantibodies and biochemical profiles, patients with tAPS have a higher risk of recurrent thrombosis than patients with oAPS, 17 supporting distinct mechanisms of pathogenesis. 18 Large scale histological studies have shown that neither thrombosis nor infarction is common in APS placentae.…”

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confidence: 94%

Antiphospholipid Antibodies in Pregnancy: Maternal and Neonatal Implications

Gris

Guillotin

Chéa

et al. 2022

Semin Thromb Hemost

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Antiphospholipid antibodies (aPL Abs) have long been associated with the occurrence of certain specific pregnancy morbidities, affecting both mother and fetus. Antithrombotic-based prophylactic regimens are the standard of care. Their intensity is modulated by the thrombotic history and has greatly improved the prognosis related to spontaneous morbidity. Observational studies show that this treatment is still associated with the persistence of excess of late-pregnancy placental diseases, calling for new or complementary developments, yet to be validated. Rigorous prospective multicentric validation of clinical and laboratory parameters capable of identifying those women and fetuses at a risk of pejorative evolution, thus early prognosis, is a priority issue. These will make it possible to develop customized treatments and test them. Furthermore, there are still concerns, particularly neurodevelopmental ones, about children born to aPL Ab-positive mothers, and clarification based on regular, more systematic evaluations is required. Even after pregnancy, women with a pure obstetrical antiphospholipid syndrome are at a greater risk of venous and arterial thrombosis over time, and prevention needs to be improved. These women also appear to develop more psychiatric and mood disorders. Central nervous system imaging using high-resolution techniques has shown subtle impairments in the white matter, associated with the most pathogenic aPL Abs and the clinical significance of this is under investigation. These mothers also seem to develop an excess of cancers. The systemic impact of aPL Abs is gradually being suspected, although this requires further evidence, and prevention should be envisaged.

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Clinical characteristics and prognosis of patients with isolated thrombotic vs. obstetric antiphospholipid syndrome: a prospective cohort study

Cited by 17 publications

References 33 publications

Deficiency of Natural Anticoagulants Involves in the Occurrence of Arterial Thrombosis

Deficiency of Natural Anticoagulants Involves in the Occurrence of Arterial Thrombosis

Long Term Follow up of Patients With Primary Obstetric Antiphospholipid Syndrome

Antiphospholipid Antibodies in Pregnancy: Maternal and Neonatal Implications

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