Abstract
The natural history of antiphospholipid antibodies (aPL) carriers is not well-established. The objectives of the present study were (a) to study the probability of developing clinical criteria of antiphospholipid syndrome (APS), (b) to identify potential risk factors for developing thrombosis and/or obstetric complications, (c) to study the association between the antibody profile and development of APS, and (d) to determine the efficacy of primary prophylaxis. We retrospectively analyzed 138 subjects with positive aPL who did not fulfill clinical criteria for APS. The mean follow-up time was 138 ± 63.0 months. Thirteen patients (9.4%) developed thrombosis after an average period of 73.0 ± 48.0 months. Independent risk factors for thrombosis were smoking, hypertension, thrombocytopenia, and triple aPL positivity. Low-dose acetyl salicylic acid did not prevent thrombotic events. A total of 28 obstetric complications were detected in 92 pregnancies. During the follow-up, only two women developed obstetric APS. Prophylactic treatment in pregnant women was associated with a better outcome in the prevention of early abortions. The thrombosis rate in patients with positive aPL who do not meet diagnostic criteria for APS is 0.82/100 patients-year. Smoking, hypertension, thrombocytopenia, and the aPL profile are independent risk factors for the development of thrombosis in aPL carriers. Although the incidence of obstetric complications in this population is high (31.6%), only a few of them meet APS criteria. In these women, prophylactic treatment might be effective in preventing early abortions.
Highlights
Antiphospholipid syndrome (APS) is an acquired immune disorder defined by the presence of thrombosis and/or pregnancy morbidity along with positive antiphospholipid antibodies, such as anticardiolipin antibodies, anti beta 2 glycoprotein antibodies (AB2GPI), and lupus anticoagulant (LA) [1]
Retrospective data were collected from 138 patients without clinical criteria for APS but with confirmed positive serology at medium or high titers separated by a minimum of 12 weeks [2]
8 out of the 39 women received treatment with acetyl salicylic acid (ASA) (100 mg/day), and ASA was associated with low weight molecular heparin (LWMH) in three of them
Summary
Antiphospholipid syndrome (APS) is an acquired immune disorder defined by the presence of thrombosis and/or pregnancy morbidity along with positive antiphospholipid antibodies (aPL), such as anticardiolipin antibodies (aCL), anti beta 2 glycoprotein antibodies (AB2GPI), and lupus anticoagulant (LA) [1]. The APS diagnosis requires both clinical (thrombosis and/or obstetric complications) and analytical evidence (confirmed presence of aPL). This is stated in the Sapporo international consensus [1], and later revised in Sydney [2]. Thrombosis rates of 3.8% have been reported in systemic lupus erythematosus (SLE) with positive aPL [5]. The annual incidence of thrombosis in patients with positive aPL antibodies but without history of thrombosis or obstetric manifestations is different between the reported studies, ranging from 0, in patients without associated disorders [6], to 1.3–2.8/100 patients-year, in studies that mix healthy population with SLE and other autoimmune diseases [7, 8].
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