Comparative study of obstetric antiphospholipid syndrome (OAPS) and non-criteria obstetric APS (NC-OAPS): report of 1640 cases from the EUROAPS registry

Abstract

Objectives To compare clinical features, laboratory data and fetal-maternal outcomes between 1000 women with obstetric APS (OAPS) and 640 with aPL-related obstetric complications not fulfilling Sydney criteria (non-criteria OAPS, NC-OAPS). Methods This was a retrospective and prospective multicentre study from the European Registry on Obstetric Antiphospholipid Syndrome. Results A total of 1650 women with 5251 episodes, 3601 of which were historical and 1650 latest episodes, were included. Altogether, 1000 cases (OAPS group) fulfilled the Sydney classification criteria and 650 (NC-OAPS group) did not. Ten NC-OAPS cases were excluded for presenting thrombosis during follow-up. All cases were classified as category I (triple positivity or double positivity for aPL) or category II (simple positivity). Overall, aPL laboratory categories showed significant differences: 29.20% in OAPS vs 17.96% in NC-OAPS (P < 0.0001) for category I, and 70.8% in OAPS vs 82% in NC-OAPS (P < 0.0001) for category II. Significant differences were observed when current obstetric complications were compared (P < 0.001). However, major differences between groups were not observed in treatment rates, livebirths and thrombotic complications. In the NC-OAPS group, 176/640 (27.5%) did not fulfil Sydney clinical criteria (subgroup A), 175/640 (27.34%) had a low titre and/or non-persistent aPL positivity but did meet the clinical criteria (subgroup B) and 289/640 (45.15%) had a high aPL titre but did not fulfil Sydney clinical criteria (subgroup C). Conclusion Significant clinical and laboratory differences were found between groups. Fetal-maternal outcomes were similar in both groups when treated. These results suggest that we could improve our clinical practice with better understanding of NC-OAPS patients.

A trial of antithrombotic therapy in patients with refractory migraine and antiphospholipid antibodies: A retrospective study of 75 patients

“…showed that in 1640 obstetric patients testing positive for aPL, those meeting and not meeting the Sydney criteria had similar treatment outcomes. 8 We likewise did not find a statistically significant difference in response in patients meeting and not meeting Sydney criteria, including those with only non-criteria aPL.…”

“…“Criteria” aPL include anticardiolipin and anti-beta-2 glycoprotein-1 antibodies and the lupus anticoagulant. There are also “non-criteria” aPL 7,8 and “non-criteria” clinical manifestations which span every specialty of medicine. 4–9…”

Risk factors associated with adverse pregnancy outcomes in patients with new-onset systemic lupus erythematosus during pregnancy

“…This result is in line with the recommendations of the European League against Rheumatism (EULAR) regarding prevention of obstetric APS, 17 and may indicate the need for active management of APS that does not completely meet the diagnostic criteria in women with SLE. 18–20…”

“…This result is in line with the recommendations of the European League against Rheumatism (EULAR) regarding prevention of obstetric APS, 17 and may indicate the need for active management of APS that does not completely meet the diagnostic criteria in women with SLE. [18][19][20] We found that the rate of pregnancy loss (encompassing early fetal loss and stillbirth) was high among women with SLE onset during pregnancy. In contrast to pregnant women with pre-existing SLE, none of the factors we analyzed were associated with pregnancy loss.…”

Illustrated State‐of‐the‐Art Capsules of the ISTH 2020 Congress

“…22 The vascular endothelium is therefore a major target of novel therapies to disrupt pathogen attachment in an attempt to slow or stop progression of sepsis to a life-threatening situation. For references see Miyakis et al, 24 Alijotis-Reig et al, 25…”