Session Information
Date: Sunday, October 21, 2018
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Anti-phospholipid antibodies (aPL) are the biomarkers of anti-phospholipid syndrome (APS), a systemic autoimmune condition characterized by thrombosis and/or pregnancy morbidity (PM). The aim of this study was to quantify the magnitude of the obstetric risk conveyed by criteria aPL, simultaneously assessing the efficacy of conventional treatment.
Methods: Data on 178 pregnancies in 60 women with persistent criteria aPL positivity (lupus anticoagulant, anti-cardiolipin and/or anti-b2GPI antibodies) were retrospectively collected (Table 1, Table 2). A weighted generalized estimating equations (GEE) model for repeated measures was applied to quantify the probability of PM conveyed by aPL, considering as covariates: number of positive aPL tests, low-dose aspirin (LDASA), low molecular weight heparin (LMWH) and their interaction; systemic autoimmune disease and age>35 years were inserted as confounders.
Results: Women with multiple aPL positivity had a probability of PM twice that of women with single aPL positivity. Women with single criteria aPL positivity had a probability of PM of 77% (95%CI 68-85), which raised to 86% (95%CI 76-93) in case of multiple aPL. Treatment with LDASA reduced the probability of PM to 29% (95%CI 11-57) in women with a single aPL test and to 44% (95%CI 17-75) in women with multiple positive tests. Among women with a single criteria aPL test receiving combo treatment, the probability of PM was 30% (95%CI 20-42). The association LDASA+LMWH reduced to 45% (95%CI 31-59) the probability of PM in women with multiple aPL tests.
Conclusion: This retrospective longitudinal cohort study showed that LDASA+LMWH allowed a significant decrease of PM in women with single but not multiple criteria aPL. Even though the association regimen led to a reduction of the probability of PM from 86% to 45% in patients with a high-risk aPL profile, it might be worth to add supplementary therapeutic tools.
Table 1.
|
|
Criteria aPL (N of patients: 60) |
|
Age at first conception, years |
30.8 (5.78) |
|
Systemic AD |
28 (46.7%) |
|
Organ-specific AD |
11 (18.3%) |
|
Pregnancy complications None ≥ 3 PrL before 10 gw PrL after 10 gw Premature birth before 34 gw |
16 (26.7%) 26 (43.3%) 10 (16.7%) 8 (13.3%) |
|
Thrombotic events Arterial Venous Arterial + venous |
12 (20.0%) 4 (6.7%) 7 (11.7%) 1 (1.6%) |
|
LA aCL IgG/IgM anti-b2GPI IgG/IgM Number of positive aPL tests 1 2 3 aPL isotypes IgG IgM IgG + IgM |
45 (75.0%) 25 (41.7%) 30 (50.0%) 37 (61.7%) 6 (10.0%) 17 (28.3%) 21 (60.0%) 9 (25.7%) 5 (14.3%) |
Table 2.
|
|
Criteria aPL (N of pregnancies: 178) |
|
Pregnancy complications None ≥ 3 PrL before 10 gw PrL after 10 gw Premature birth before 34 gw |
72 (40.5%) 68 (38.2%) 23 (12.9%) 15 (8.4%) |
|
Treatments None LDASA [+ HCQ] LDASA + LMWH [+ HCQ] LMWH HCQ |
81 (45.5%) 18 [8] (14.6%) 52 [14] (37.1%) 4 (2.2%) 1 (0.6%) |
To cite this abstract in AMA style:
Chighizola CB, Pregnolato F, Raimondo MG, Comerio C, Trespidi L, Borghi MO, Gerosa M, Acaia B, Ossola W, Ferrazzi E, Bulfoni A, Meroni PL. The Efficacy of Treatment with Low Dose Aspirin and Low Molecular Weight Heparin in Pregnant Women with Criteria Anti-Phospholipid Antibodies [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/the-efficacy-of-treatment-with-low-dose-aspirin-and-low-molecular-weight-heparin-in-pregnant-women-with-criteria-anti-phospholipid-antibodies/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-efficacy-of-treatment-with-low-dose-aspirin-and-low-molecular-weight-heparin-in-pregnant-women-with-criteria-anti-phospholipid-antibodies/