Morbidity and mortality in the antiphospholipid syndrome during a 5-year period: a multicentre prospective study of 1000 patients

Abstract

Objectives:To identify the main causes of morbidity and mortality in patients with antiphospholipid syndrome (APS) during a 5-year period and to determine clinical and immunological parameters with prognostic significance.Methods:The clinical and immunological features of a cohort of 1000 patients with APS from 13 European countries who had been followed up from 1999 to 2004 were analysed.Results:200 (20%) patients developed APS-related manifestations during the 5-year study period. Recurrent thrombotic events appeared in 166 (16.6%) patients and the most common were strokes (2.4% of the total cohort), transient ischaemic attacks (2.3%), deep vein thromboses (2.1%) and pulmonary embolism (2.1%). When the thrombotic events occurred, 90 patients were receiving oral anticoagulants and 49 were using aspirin. 31/420 (7.4%) patients receiving oral anticoagulants presented with haemorrhage. 3/121 (2.5%) women with only obstetric APS manifestations at the start of the study developed a new thrombotic event. A total of 77 women (9.4% of the female patients) had one or more pregnancies and 63 (81.8% of pregnant patients) had one or more live births. The most common fetal complications were early pregnancy loss (17.1% of pregnancies) and premature birth (35% of live births). 53 (5.3% of the total cohort) patients died. The most common causes of death were bacterial infection (21% of deaths), myocardial infarction (19%) and stroke (13%). No clinical or immunological predictor of thrombotic events, pregnancy morbidity or mortality was detected.Conclusion:Patients with APS still develop significant morbidity and mortality despite current treatment (oral anticoagulants or antiaggregants, or both).

Thrombotic recurrences and bleeding events in APS vascular patients: A review from the literature and a comparison with the APS Piedmont Cohort

“…The paper by Cervera et al [23] reports the results of the largest APS cohort ever studied. It is a prospective, multicenter study.…”

Venous Thromboembolic Disease

“…Antiphospholipid antibodies have been associated with an increased risk of venous and arterial thromboembolism and adverse pregnancy outcomes. [137][138][139] Any patient who has experienced a thrombotic event and fulfills diagnostic criteria for antiphospholipid syndrome should be considered for indefinite anticoagulation therapy.…”

A male patient with myocardial infarction as a first manifestation of antiphospholipid syndrome — treatment with rivaroxaban

“…badania Cervery i wsp. [9] przeprowadzone w grupie 1000 pacjentów z APS, w której drugą z kolei przyczyną zgonu po infekcjach bakteryjnych (21%) był zawał serca (19%). Stwierdzono, że pacjenci z aPL poddani przezskórnej interwencji wieńcowej częściej wymagają rewaskularyzacji i występuje u nich więcej ponownych epizodów sercowo-naczyniowych w obserwacji odległej niż u osób bez tych przeciwciał [10].…”