title: Treatment strategies and pregnancy outcomes in antiphospholipid syndrome patients with thrombosis and triple antiphospholipid positivity. A European multicentre retrospective study.
abstract: Previous thrombosis, diagnosis of systemic lupus erythematosus (SLE) and triple antiphospholipid (aPL) antibody positivity have recently been found to be independent factors associated to pregnancy failure during conventional therapy in women with antiphospholipid syndrome (APS). This study aimed to assess the effect of various treatment strategies on pregnancy outcomes in women with APS and the risk factors for pregnancy failure. One hundred ninety-six pregnancies of 156 patients diagnosed with APS were analysed: 118 (60.2%) of these had previous thrombosis, 81 (41.3%) were diagnosed with SLE, and 107 (54.6%) had triple aPL positivity. One hundred seventy-five (89.3%) were treated with conventional therapies (low-dose aspirin [LDA] or prophylactic doses of heparin + LDA or therapeutic doses of heparin + LDA), while 21 (10.7%) were prescribed other treatments in addition to conventional therapy. The pregnancies were classified into seven risk profiles depending on the patients' risk factors - thrombosis, SLE, and triple aPL positivity - and their single, double or triple combinations. It was possible to find significant difference in outcomes correlated to treatments only in the thrombosis plus triple aPL positivity subset, and logistic regression analysis showed that additional treatments were the only independent factor associated to a favourable pregnancy outcome (odds ratio=9.7, 95% confidence interval=1.1-88.9, p-value<0.05). On the basis of this retrospective study, we found that APS pregnant patients with thrombosis and triple aPL positivity treated with additional therapy had a significant higher live-birth rate with respect to those receiving conventional therapy alone.
authors.affiliation: Amelia Ruffatti, Reumatologia, Policlinico Universitario, Via Giustiniani, 2 - 35128 Padova, Italy, Tel.: +039 049 8212192, Fax: +039 049 8212191, E-mail: amelia.ruffatti@unipd.it.
authors.forename: Amelia
authors.initials: A
authors.lastname: Ruffatti
authors.forename: Elisa
authors.initials: E
authors.lastname: Salvan
authors.forename: Teresa
authors.initials: T
authors.lastname: Del Ross
authors.forename: Maria
authors.initials: M
authors.lastname: Gerosa
authors.forename: Laura
authors.initials: L
authors.lastname: Andreoli
authors.forename: Aldo
authors.initials: A
authors.lastname: Maina
authors.forename: Jaume
authors.initials: J
authors.lastname: Alijotas-Reig
authors.forename: Sara
authors.initials: S
authors.lastname: De Carolis
authors.forename: Arsene
authors.initials: A
authors.lastname: Mekinian
authors.forename: Maria Tiziana
authors.initials: MT
authors.lastname: Bertero
authors.forename: Valentina
authors.initials: V
authors.lastname: Canti
authors.forename: Antonio
authors.initials: A
authors.lastname: Brucato
authors.forename: Katarina
authors.initials: K
authors.lastname: Bremme
authors.forename: Véronique
authors.initials: V
authors.lastname: Ramoni
authors.forename: Marta
authors.initials: M
authors.lastname: Mosca
authors.forename: Emma
authors.initials: E
authors.lastname: Di Poi
authors.forename: Paola
authors.initials: P
authors.lastname: Caramaschi
authors.forename: Mauro
authors.initials: M
authors.lastname: Galeazzi
authors.forename: Angela
authors.initials: A
authors.lastname: Tincani
authors.forename: Laura
authors.initials: L
authors.lastname: Trespidi
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Meroni
mesh_terms: D000328:Adult; D017152:Antibodies, Antiphospholipid / Q000276:immunology; D016736:Antiphospholipid Syndrome / Q000097:blood* / Q000150:complications*; D001241:Aspirin / Q000008:administration & dosage; D005060:Europe; D005260:Female; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology; D007075:Immunoglobulin M / Q000276:immunology; D008180:Lupus Erythematosus, Systemic / Q000276:immunology; D008875:Middle Aged; D016017:Odds Ratio; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000097:blood / Q000150:complications
chemical_list: D017152:Antibodies, Antiphospholipid; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D006493:Heparin; D001241:Aspirin
keywords: Antiphospholipid antibodies; antiphospholipid syndrome; pregnancy; risk factors; treatment