Abstract Number: OC 06.3
Meeting: ISTH 2022 Congress
Background: Significant limitations in the data used to define the optimal thromboprophylaxis in patients with antiphospholipid antibodies (aPLAbs) and thrombosis include uncertainties in patients with an initial provoked venous thromboembolic event (VTE).
Aims: To describe thrombotic outcomes in women with a first combined oral contraceptives (COC)-associated first VTE and positive aPLAbs, and a low risk of recurrence.
Methods: International multicentric retrospective study on patients referred for thrombophilia screening after a first COC-associated VTE between January 1st 2010 and January 1st 2021, with low risk by HERDOO2 score, taking a low-dose aspirin-mediated secondary thromboprophylaxis, followed each year until 2021. Primary outcome: thrombosis recurrence rate. Secondary outcomes: recurrence rates by the initial VTE subtype (distal deep vein thrombosis DVT, proximal DVT, pulmonary embolism PE); major bleedings.
Results: Data from 264 patients (distal DVT: 62.9%, proximal DVT: 20.1%, PE: 17%), cumulating 1,327.7 patient.years of observation, were collected. Twenty-two thrombosis occurred: 16 distal DVTs, 3 proximal DVTs, 1 PE and 2 transient ischaemic attacks, the recurrence rate of thrombosis being 1.66 per 100 patient.years (p.y; 95%CI: 1 – 2.3). The recurrence rate was 1.06, 2.88 and 2.57 per 100 p.y in women with distal DVT, proximal DVT and PE, respectively (p=0.0336). No major bleeding occurred. Risk factors affecting thrombosis-recurrence free survival of patients were the time between first COC intake and VTE (p < 0.0001), initial proximal DVT (p=0.0035), active smoking (p=0.0008), high positivity for anti-b2GP1 IgG (p=0.0181) and for anti-b2GP1 IgM (p=0.0321).
Conclusion(s): In women with thrombotic antiphospholipid syndrome diagnosed after a first COC-induced VTE, with a low HERDOO2 score, under low-dose aspirin secondary prophylaxis, those with distal DVT had a low risk of recurrence. Recurrence risks were higher in others and was modulated by simple cofactors. These observational data may give some clues for categorising the patients in future randomised controlled trials.
To cite this abstract in AMA style:
GRIS J, Bourguignon C, Bouvier S, Nouvellon E, Laurent J, Perez-Martin A, Mousty E, Nikolaeva M, Khizroeva J, Bitsadze V, makatsariya A. Combined oral contraceptive-associated venous thromboembolism revealing an antiphospholipid syndrome: an international retrospective study of outcomes. [abstract]. https://abstracts.isth.org/abstract/combined-oral-contraceptive-associated-venous-thromboembolism-revealing-an-antiphospholipid-syndrome-an-international-retrospective-study-of-outcomes/. Accessed March 21, 2024.« Back to ISTH 2022 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/combined-oral-contraceptive-associated-venous-thromboembolism-revealing-an-antiphospholipid-syndrome-an-international-retrospective-study-of-outcomes/