TY - JOUR
T1 - Patients with antiphosholipid syndrome and thrombotic recurrences
T2 - A real world observation (the Piedmont cohort study)
AU - Piedmont APS Consortium
AU - Bazzan, M.
AU - Vaccarino, A.
AU - Stella, S.
AU - Sciascia, S.
AU - Montaruli, B.
AU - Bertero, M. T.
AU - Carignola, R.
AU - Roccatello, D.
AU - Osvaldo, Giachino
AU - Binello, Giovanni
AU - Luisa, Sosso
AU - Valeria, Data
AU - Patrizia, Bigo
AU - Cristiana, Rollino
AU - Michela, Ferro
AU - Eirini, Karvela
AU - Raffaele, Pellerito
AU - Emanuela, Bellis
AU - Piercarla, Schinco
AU - Piera, Sivera
AU - Anna, Kuzenko
AU - Emanuela, Napolitano
AU - Domenico, Cosseddu
AU - Cristiana, Marchese
AU - Nicoletta, Romeo
AU - Giulia, Seminara
AU - Maria, Stefanidou Erato
AU - Molinari, Filippo
AU - Contino, Laura
AU - Gabriella, Nallino Maria
AU - Calvi, Roberta
AU - Stratta, Piero
AU - Bizzocchi, Agata
AU - Bobbio, Flavio
AU - Sainaghi, Pier Paolo
AU - Sola, Daniele
N1 - Publisher Copyright:
© The Author(s), 2015.
PY - 2016/4/1
Y1 - 2016/4/1
N2 - Background: Patients with antiphospholipid syndrome (APS) often have thrombotic recurrences, sometimes despite appropriate ongoing anticoagulant treatment. Identifying APS vascular patients at high risk for thrombotic recurrences is still an unsolved issue. Objectives: To report the real-life experience of thrombotic recurrences in APS patients included in the Piedmont observational cohort study, and evaluate clinical and laboratory risk factors for thrombotic recurrences. Patients: A multi-centre observational study was performed by enrolling 177 patients with vascular APS (primary APS in 99 subjects (56%)); the median 1 follow-up was five years (range 1-26 years). Results: The observed thrombotic recurrence rate was about 7.5/100 patient years in the first five years after the first thrombotic event. While the first recurrence often occurred (45%) in patients who were not on oral anticoagulant therapy (OAT), the second recurrence mainly occurred despite ongoing OAT (80%). However, due to the real-life observational nature of this study, treatment was based on the treating physician's judgement, and no structured therapeutic protocol was applied. Moreover, compliance with OAT was not available. No differences in antiphospholipid antibodies (aPL) profile were observed between patients with or without thrombotic recurrences, but a high risk aPL profile (Miyakis type 1 and 2a) was present in 96% of our patients, 26% of whom had triple positivity. Diabetes (p<0.01, OR 10), inherited thrombophilia (p<0.0078, OR 4) and OAT withdrawal were independent risk factors for recurrences. Conclusions: With the limit of a real-life observational cohort study, the thrombotic recurrence rate in APS was as high as 7.5/100 patient years in the first five years after the first thrombotic event. OAT discontinuation, diabetes and inherited thrombophilia, when associated with a high-risk aPL profile, are risk factors for thrombotic recurrences.
AB - Background: Patients with antiphospholipid syndrome (APS) often have thrombotic recurrences, sometimes despite appropriate ongoing anticoagulant treatment. Identifying APS vascular patients at high risk for thrombotic recurrences is still an unsolved issue. Objectives: To report the real-life experience of thrombotic recurrences in APS patients included in the Piedmont observational cohort study, and evaluate clinical and laboratory risk factors for thrombotic recurrences. Patients: A multi-centre observational study was performed by enrolling 177 patients with vascular APS (primary APS in 99 subjects (56%)); the median 1 follow-up was five years (range 1-26 years). Results: The observed thrombotic recurrence rate was about 7.5/100 patient years in the first five years after the first thrombotic event. While the first recurrence often occurred (45%) in patients who were not on oral anticoagulant therapy (OAT), the second recurrence mainly occurred despite ongoing OAT (80%). However, due to the real-life observational nature of this study, treatment was based on the treating physician's judgement, and no structured therapeutic protocol was applied. Moreover, compliance with OAT was not available. No differences in antiphospholipid antibodies (aPL) profile were observed between patients with or without thrombotic recurrences, but a high risk aPL profile (Miyakis type 1 and 2a) was present in 96% of our patients, 26% of whom had triple positivity. Diabetes (p<0.01, OR 10), inherited thrombophilia (p<0.0078, OR 4) and OAT withdrawal were independent risk factors for recurrences. Conclusions: With the limit of a real-life observational cohort study, the thrombotic recurrence rate in APS was as high as 7.5/100 patient years in the first five years after the first thrombotic event. OAT discontinuation, diabetes and inherited thrombophilia, when associated with a high-risk aPL profile, are risk factors for thrombotic recurrences.
KW - Anticoagulation
KW - antiphospholipid syndrome
KW - thrombosis
UR - https://www.scopus.com/pages/publications/84962542199
U2 - 10.1177/0961203315617538
DO - 10.1177/0961203315617538
M3 - Article
SN - 0961-2033
VL - 25
SP - 479
EP - 485
JO - Lupus
JF - Lupus
IS - 5
ER -
