Abstract Number: LPB0093
Meeting: ISTH 2021 Congress
Background: About 20% of POAPS patients, even under conventional treatment (CT) during pregnancy, still are at a high risk of suffering from obstetric morbidity.
Aims: To evaluate the clinical utility of aGAPSS to assess the risk of a new obstetric event on POAPS patients under CT during pregnancy.
Methods: 107 pregnancies from women with POAPS treated with CT were retrospectively evaluated [median age: 31 years; (28-36)]. CT included low dose aspirin and a prophylactic low molecular weight heparin/day. At the time of diagnosis, clinical and laboratory variables were evaluated and the aGAPSS was calculated. Treatment failure was defined as any of the following obstetric outcomes: early or late miscarriage, fetal loss, early severe pre-eclampsia and/or fetal growth restriction.
Results: Among the 107 pregnancies that were followed up, in 91 (85.1%) live births were achieved while 16 (14.9%) resulted in pregnancy loss: 12 (11.2%) miscarriages and 4 (3.7%) fetal losses. Fetal growth restriction in 7 (6.5%) and early severe pre-eclampsia in 4 (3.7%) pregnancies. Thus, CT failed in 23 pregnancies (21.5%).
The presence of triple positivity for antiphospholipid antibodies (aPL) [OR=8.410 (95% CI: 2.732-26.210), p<0.001], and an aGAPSS ≥7 [OR=3.664 (95% CI: 1.407-9.541), p=0.008] were associated with a higher chance of treatment failure. However, after multivariate analysis, only the triple positivity for aPL [OR=8.462 (95% CI: 2.732-26.210); p<0.0001] was found to be a strong risk factor independently associated with treatment failure.
|APS Risk Factors||Conventional treatment failure||p|
|No (n= 84)||Yes (n=23)|
|aGAPSS value||5.8 (±2.99)||8.7 (±4.37)|
|Triple positivity of aPL||8.3% (7/84)||43.5% (10/23)||p<0.001|
|aGAPSS≥7||26.2% (22/84)||56.6% (13/23)||p=0.01|
|Cardiovascular Risk Factors:|
|Hyperlipidemia||4.8% (4/84)||4.3% (1/23)||NS|
|Arterial hypertension||8.3 % (7/84)||13.0 % (3/23)||NS|
|Smoking habit||7.1 % (6/84)||17.4 % (4/23)||NS|
|Obesity||8.3 % (7/84)||13.0 % (3/23)||NS|
Conclusions: A high aGAPSS (≥7) would not be an independent risk factor for CT failure. In fact, the triple positivity of aPL would actually be an indicator of poorer response to CT and worse prognosis. Arterial hypertension and hyperlipidemia might have a significantly lesser contribution than triple positivity of aPL to the aGAPSS thus decreasing its potential as a prognostic marker.
To cite this abstract in AMA style:de Larrañaga G, Aranda F, Perés Wingeyer S, Udry S, Morales Perez S, Belizna C, Alijotas-Reig J, Esteve-Valverde E, Fernández Romero DS, Latino J. An Overall Evaluation of the Adjusted Version of Global Antiphospholipid Syndrome Score (aGAPSS) on Primary Obstetric Antiphospholipid Syndrome (POAPS) Patients [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 1). https://abstracts.isth.org/abstract/an-overall-evaluation-of-the-adjusted-version-of-global-antiphospholipid-syndrome-score-agapss-on-primary-obstetric-antiphospholipid-syndrome-poaps-patients/. Accessed September 24, 2021.
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