Objectives: 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. Conclusion: Patients with APS still develop significant morbidity and mortality despite current treatment (oral anticoagulants or antiaggregants, or both).

Morbidity and mortality in the antiphospholipid syndrome during a 5-year period : a multicentre prospective study of 1000 patients / R. Cervera, M.A. Khamashta, Y. Shoenfeld, M.T. Camps, S. Jacobsen, E. Kiss, M.M. Zeher, A. Tincani, I. Kontopoulou-Griva, M. Galeazzi, F. Bellisai, P. Meroni, R.H. Derksen, P.G. de Groot, E. Gromnica-Ihle, M. Baleva, M. Mosca, S. Bombardieri, F. Houssiau, J.C. Gris, I. Quéré, E. Hachulla, C. Vasconcelos, B. Roch, A. Fernandez-Nebro, J.C. Piette, G. Espinosa, S. Bucciarelli, C.N. Pisoni, M.L. Bertolaccini, M.C. Boffa, G.R. Hughes. - In: ANNALS OF THE RHEUMATIC DISEASES. - ISSN 0003-4967. - 68:9(2009 Sep), pp. 1428-1432.

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

P. Meroni;
2009

Abstract

Objectives: 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. Conclusion: Patients with APS still develop significant morbidity and mortality despite current treatment (oral anticoagulants or antiaggregants, or both).
Settore MED/16 - Reumatologia
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/67184
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