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


CONCLUSIONS
Patients with APS still develop significant morbidity and mortality despite current treatment (oral anticoagulants or antiaggregants, or both).
Cervera
R
R
Servei de Malalties Autoimmunes, Hospital Clínic, Villarroel 170, 08036-Barcelona, Catalonia, Spain. rcervera@clinic.ub.es
Khamashta
M A
MA
Shoenfeld
Y
Y
Camps
M T
MT
Jacobsen
S
S
Kiss
E
E
Zeher
M M
MM
Tincani
A
A
Kontopoulou-Griva
I
I
Galeazzi
M
M
Bellisai
F
F
Meroni
P L
PL
Derksen
R H W M
RH
de Groot
P G
PG
Gromnica-Ihle
E
E
Baleva
M
M
Mosca
M
M
Bombardieri
S
S
Houssiau
F
F
Gris
J-C
JC
Quéré
I
I
Hachulla
E
E
Vasconcelos
C
C
Roch
B
B
Fernández-Nebro
A
A
Piette
J-C
JC
Espinosa
G
G
Bucciarelli
S
S
Pisoni
C N
CN
Bertolaccini
M L
ML
Boffa
M-C
MC
Hughes
G R V
GR
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage; D016736:Antiphospholipid Syndrome / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D004363:Drug Utilization / Q000706:statistics & numerical data; D004812:Epidemiologic Methods; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013927:Thrombosis / Q000453:epidemiology; D055815:Young Adult
D000925:Anticoagulants