title: Comparative incidence of a first thrombotic event in purely obstetric antiphospholipid syndrome with pregnancy loss: the NOH-APS observational study.
abstract: The incidence of thrombosis in the purely obstetric form of antiphospholipid syndrome is uncertain. We performed a 10-year observational study of 1592 nonthrombotic women who had experienced 3 consecutive spontaneous abortions before the 10th week of gestation or 1 fetal death at or beyond the 10th week of gestation. We compared the frequencies of thrombotic events among women positive for antiphospholipid Abs (n = 517), women carrying the F5 6025 or F2 rs1799963 polymorphism (n = 279), and women with negative thrombophilia screening results (n = 796). The annual rates of deep vein thrombosis (1.46%; range, 1.15%-1.82%), pulmonary embolism (0.43%; range, 0.26%-0.66%), superficial vein thrombosis (0.44%; range, 0.28%-0.68%), and cerebrovascular events (0.32%; range, 0.18%-0.53%) were significantly higher in aPLAbs women than in the other groups despite low-dose aspirin primary prophylaxis. Women carrying 1 of the 2 polymorphisms did not experience more thrombotic events than women who screened negative for thrombophilia. Lupus anticoagulant was a risk factor for unprovoked proximal and distal deep and superficial vein thrombosis and women in the upper quartile of lupus anticoagulant activity had the highest risk. Despite data suggesting that aPLAbs may induce pregnancy loss through nonthrombotic mechanisms, women with purely obstetric antiphospholipid syndrome are at risk for thrombotic complications.
authors.affiliation: Department of Hematology, University Hospital, Nîmes, France. jcgris@chu-nimes.fr
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Gris
authors.forename: Sylvie
authors.initials: S
authors.lastname: Bouvier
authors.forename: Nicolas
authors.initials: N
authors.lastname: Molinari
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Galanaud
authors.forename: Eva
authors.initials: E
authors.lastname: Cochery-Nouvellon
authors.forename: Erik
authors.initials: E
authors.lastname: Mercier
authors.forename: Pascale
authors.initials: P
authors.lastname: Fabbro-Peray
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Balducchi
authors.forename: Pierre
authors.initials: P
authors.lastname: Marès
authors.forename: Isabelle
authors.initials: I
authors.lastname: Quéré
authors.forename: Michel
authors.initials: M
authors.lastname: Dauzat
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology* / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017152:Antibodies, Antiphospholipid / Q000097:blood; D016736:Antiphospholipid Syndrome / Q000150:complications / Q000453:epidemiology* / Q000235:genetics; D005165:Factor V / Q000235:genetics*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D016682:Lupus Coagulation Inhibitor / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011110:Polymorphism, Genetic / Q000235:genetics*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D011516:Prothrombin / Q000235:genetics*; D012307:Risk Factors; D019851:Thrombophilia / Q000453:epidemiology / Q000209:etiology; D013927:Thrombosis / Q000453:epidemiology* / Q000209:etiology; D020246:Venous Thrombosis / Q000453:epidemiology / Q000209:etiology; D055815:Young Adult
chemical_list: D017152:Antibodies, Antiphospholipid; D016682:Lupus Coagulation Inhibitor; D005165:Factor V; D011516:Prothrombin