Corrigendum to: Comparative study of obstetric antiphospholipid syndrome (OAPS) and non-criteria obstetric APS (NC-OAPS): report of 1640 cases from EUROAPS registry

SummaryAccurate diagnosis of obstetric antiphospholipid syndrome (APS) is a prerequisite for optimal clinical management. The international consensus (revised Sapporo) criteria for obstetric APS do not include low positive anticardiolipin (aCL) and anti β2 glycoprotein I (aβ2GPI) antibodies (> 99th centile) and/or certain clinical criteria such as two unexplained miscarriages, three non-consecutive miscarriages, late preeclampsia, placental abruption, late premature birth, or two or more unexplained in vitro fertilisation failures. In this review we examine the available evidence to address the question of whether patients who exhibit non-criteria clinical and/or laboratory manifestations should be included within the spectrum of obstetric APS. Prospective and retrospective cohort studies of women with pregnancy morbidity, particularly recurrent pregnancy loss, suggest that elimination of aCL and/or IgM aβ2GPI, or low positive positive aCL or aβ2GPI from APS laboratory diagnostic criteria may result in missing the diagnosis in a sizeable number of women who could be regarded to have obstetric APS. Such prospective and retrospective studies also suggest that women with non-criteria obstetric APS may benefit from standard treatment for obstetric APS with low-molecular-weight heparin plus low-dose aspirin, with good pregnancy outcomes. Thus, non-criteria manifestations of obstetric APS may be clinically relevant, and merit investigation of therapeutic approaches. Women with obstetric APS appear to be at a higher risk than other women of pre-eclampsia, placenta- mediated complications and neonatal mortality, and also at increased long-term risk of thrombotic events. The applicability of these observations to outcomes in women with non-criteria obstetric APS remains to be determined.

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Comparison of treatments for the prevention of fetal growth restriction in obstetric antiphospholipid syndrome: a systematic review and network meta-analysis

Internal and Emergency Medicine ◽

10.1007/s11739-020-02609-4 ◽

2021 ◽

Author(s):

Maria Letizia Urban ◽

Alessandra Bettiol ◽

Irene Mattioli ◽

Giacomo Emmi ◽

Gerardo Di Scala ◽

...

Keyword(s):

Systematic Review ◽

Preterm Birth ◽

Antiphospholipid Syndrome ◽

Fetal Growth ◽

Fetal Growth Restriction ◽

Neonatal Death ◽

Meta Analysis ◽

Increased Risk ◽

Obstetric Antiphospholipid Syndrome ◽

Obstetric Aps

AbstractWomen with criteria and non-criteria obstetric antiphospholipid syndrome (APS) carry an increased risk of pregnancy complications, including fetal growth restriction (FGR). The management of obstetric APS traditionally involves clinicians, obstetricians and gynaecologists; however, the most appropriate prophylactic treatment strategy for FGR prevention in APS is still debated. We performed a systematic review and network meta-analysis (NetMA) to summarize current evidence on pharmacological treatments for the prevention of FGR in APS. We searched PubMed and Embase from inception until July 2020, for randomized controlled trials and prospective studies on pregnant women with criteria or non-criteria obstetric APS. NetMA using a frequentist framework were conducted for the primary outcome (FGR) and for secondary outcomes (fetal or neonatal death and preterm birth). Adverse events were narratively summarised. Out of 1124 citations, we included eight studies on 395 pregnant patients with obstetric APS treated with low-dose aspirin (LDA) + unfractionated heparin (UFH) (n = 132 patients), LDA (n = 115), LDA + low molecular weight heparin (n = 100), LDA + corticosteroids (n = 29), LDA + UFH + intravenous immunoglobulin (n = 7), or untreated (n = 12). No difference among treatments emerged in terms of FGR prevention, but estimates were largely imprecise, and most studies were at high/unclear risk of bias. An increased risk of fetal or neonatal death was found for LDA monotherapy as compared to LDA + heparin, and for no treatment as compared to LDA + corticosteroids. The risk of preterm birth was higher for LDA + UFH + IVIg as compared to LDA or LDA + heparin, and for LDA + corticosteroids as compared to LDA or LDA + LMWH. No treatment was associated with an increased risk of bleeding, thrombocytopenia or osteopenia.

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Comparative study between obstetric antiphospholipid syndrome and obstetric morbidity related with antiphospholipid antibodies

Medicina Clínica ◽

10.1016/j.medcli.2017.11.017 ◽

2018 ◽

Vol 151 (6) ◽

pp. 215-222 ◽

Cited By ~ 9

Author(s):

Jaume Alijotas-Reig ◽

Enrique Esteve-Valverde ◽

Raquel Ferrer-Oliveras ◽

Elisa LLurba ◽

Amelia Ruffatti ◽

...

Keyword(s):

Comparative Study ◽

Antiphospholipid Syndrome ◽

Antiphospholipid Antibodies ◽

Obstetric Morbidity ◽

Obstetric Antiphospholipid Syndrome

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16th International Congress on Antiphospholipid Antibodies Task Force Report on Obstetric Antiphospholipid Syndrome

Lupus ◽

10.1177/0961203320954520 ◽

2020 ◽

Vol 29 (12) ◽

pp. 1601-1615 ◽

Cited By ~ 1

Author(s):

Guilherme R de Jesús ◽

Ashley E Benson ◽

Cecilia B Chighizola ◽

Savino Sciascia ◽

David W Branch

Keyword(s):

Antiphospholipid Syndrome ◽

Antiphospholipid Antibodies ◽

Task Force ◽

International Congress ◽

Clinical Aspects ◽

Task Force Report ◽

Obstetric Morbidity ◽

Obstetric Antiphospholipid Syndrome ◽

Obstetric Aps ◽

Based Medicine

Obstetric antiphospholipid syndrome (APS) remains a clinical challenge for practitioners, with several controversial points that have not been answered so far. This Obstetric APS Task Force met on the 16th International Congress on Antiphospholipid Antibodies in Manchester, England, to discuss about treatment, diagnostic and clinical aspects of the disease. This report will address evidence-based medicine related to obstetric APS, including limitations on our current management, the relationship between antibodies against domain 1 of β2GPI and obstetric morbidity, hydroxychloroquine use in patients with obstetric APS and factors associated with thrombosis after obstetric APS. Finally, future directions for better understanding this complex condition are also reported by the Task Force coordinators.

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Comparative incidence of pregnancy outcomes in treated obstetric antiphospholipid syndrome: the NOH-APS observational study

Blood ◽

10.1182/blood-2013-08-522623 ◽

2014 ◽

Vol 123 (3) ◽

pp. 404-413 ◽

Cited By ~ 79

Author(s):

Sylvie Bouvier ◽

Éva Cochery-Nouvellon ◽

Géraldine Lavigne-Lissalde ◽

Érick Mercier ◽

Tess Marchetti ◽

...

Keyword(s):

Observational Study ◽

Antiphospholipid Syndrome ◽

Pregnancy Outcomes ◽

Pregnancy Complications ◽

Fetal Loss ◽

Late Pregnancy ◽

Key Points ◽

Obstetric Antiphospholipid Syndrome ◽

Obstetric Aps

Key PointsAmong women with pure obstetric APS, late pregnancy complications are more frequent in cases of prior fetal loss. Late pregnancy complications are more frequent among women treated for pure obstetric APS than among nontreated controls.

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Comparative study of obstetric antiphospholipid syndrome (OAPS) and non-criteria obstetric APS (NC-OAPS): report of 1640 cases from the EUROAPS registry

Rheumatology ◽

10.1093/rheumatology/kez419 ◽

2019 ◽

Vol 59 (6) ◽

pp. 1306-1314 ◽

Cited By ~ 6

Author(s):

Jaume Alijotas-Reig ◽

Enrique Esteve-Valverde ◽

Raquel Ferrer-Oliveras ◽

Luis Sáez-Comet ◽

Elmina Lefkou ◽

...

Keyword(s):

Antiphospholipid Syndrome ◽

Laboratory Data ◽

Obstetric Complications ◽

Maternal Outcomes ◽

Clinical Criteria ◽

Prospective Multicentre Study ◽

Thrombotic Complications ◽

Obstetric Antiphospholipid Syndrome ◽

Obstetric Aps

Abstract Objectives To compare clinical features, laboratory data and fetal-maternal outcomes between 1000 women with obstetric APS (OAPS) and 640 with aPL-related obstetric complications not fulfilling Sydney criteria (non-criteria OAPS, NC-OAPS). Methods This was a retrospective and prospective multicentre study from the European Registry on Obstetric Antiphospholipid Syndrome. Results A total of 1650 women with 5251 episodes, 3601 of which were historical and 1650 latest episodes, were included. Altogether, 1000 cases (OAPS group) fulfilled the Sydney classification criteria and 650 (NC-OAPS group) did not. Ten NC-OAPS cases were excluded for presenting thrombosis during follow-up. All cases were classified as category I (triple positivity or double positivity for aPL) or category II (simple positivity). Overall, aPL laboratory categories showed significant differences: 29.20% in OAPS vs 17.96% in NC-OAPS (P < 0.0001) for category I, and 70.8% in OAPS vs 82% in NC-OAPS (P < 0.0001) for category II. Significant differences were observed when current obstetric complications were compared (P < 0.001). However, major differences between groups were not observed in treatment rates, livebirths and thrombotic complications. In the NC-OAPS group, 176/640 (27.5%) did not fulfil Sydney clinical criteria (subgroup A), 175/640 (27.34%) had a low titre and/or non-persistent aPL positivity but did meet the clinical criteria (subgroup B) and 289/640 (45.15%) had a high aPL titre but did not fulfil Sydney clinical criteria (subgroup C). Conclusion Significant clinical and laboratory differences were found between groups. Fetal-maternal outcomes were similar in both groups when treated. These results suggest that we could improve our clinical practice with better understanding of NC-OAPS patients.

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Clinical characteristics and prognosis of patients with isolated thrombotic vs. obstetric antiphospholipid syndrome: a prospective cohort study

Arthritis Research & Therapy ◽

10.1186/s13075-021-02515-w ◽

2021 ◽

Vol 23 (1) ◽

Author(s):

Hui Jiang ◽

Chu-Han Wang ◽

Nan Jiang ◽

Jing Li ◽

Chan-Yuan Wu ◽

...

Keyword(s):

Antiphospholipid Syndrome ◽

Clinical Characteristics ◽

Antiphospholipid Antibody ◽

Primary Antiphospholipid Syndrome ◽

College Hospital ◽

Medical College ◽

Obstetric Antiphospholipid Syndrome ◽

Obstetric Aps ◽

Biochemical Profiles

Abstract Background Several studies suggested that thrombotic and obstetric antiphospholipid syndromes could be independent identities, but few have systematically compared their clinical characteristics and prognosis. Objective The objective of this study is to identify key differences between thrombotic APS (tAPS) and obstetric APS (oAPS). Methods This single-center, prospective study included consecutive patients with primary antiphospholipid syndrome (APS) receiving treatment at the Peking Union Medical College Hospital during a period from 2013 to 2020. Results Screening of the database yielded a total of 244 women with positive antiphospholipid antibody (aPL). Among the 105 women with primary APS, 39 (37.14%) had isolated tAPS (ItAPS), 44 (41.90%) had isolated oAPS (IoAPS), and 9 (8.57%) had both tAPS and tAPS+oAPS. In comparison to those with IoAPS, patients with ItAPS had older age (41.92 ± 11.97 vs. 33.16 ± 4.22 years, P < 0.01), higher rate of cardiovascular risk (at least one positive of coronary heart disease, hypertension, obesity, diabetes, and hyperlipidemia) (41.03% vs. 6.82%, P < 0.01), and higher frequency of thrombocytopenia (43.59% vs. 20.45%, P < 0.05). Antibody profiles were generally similar among the groups, but isolated anti-β2GPI positivity was more common in patients with IoAPS (52.27% vs. 17.94% for ItAPS, P = 0.01). Triple aPL positivity was more common in patients with both tAPS and oAPS (66.67% vs. 46.15% for ItAPS vs. 25% for IoAPS, P = 0.022). Blood homocysteine was higher in patients with ItAPS (11.20 vs. 9.90 μmol/L for IoAPS, P < 0.05), but there were no differences in inflammatory markers or complements. Recurrence rate of thrombosis was higher in patients with ItAPS (33.33% vs. 2.27% for IoAPS, P ≤ 0.001) with a mean follow-up of 61 months. Conclusion Despite generally similar antibody and biochemical profiles, patients with ItAPS had much higher risk of recurrent thrombosis than IoAPS, supporting distinct mechanisms of pathogenesis.

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