Abstract Number: PB2542
Meeting: ISTH 2020 Congress
Background: Patients with Anti-phospholipid Syndrome may be stratified in terms of risk for future thrombotic and/or obstetric events, depending on the number of positivity of antiphospholipid antibodies (aPL: lupus anticoagulant, anticardiolipin antibodies, aβ2Glicoprotein I antibodies), titers of aPL, and the clinical manifestations associated with aPL. However, there are few studies exploring the effects of additional treatment in high-risk obstetric APS (OAPS) patients on preventing severe preeclampsia (sPE).
Aims: The aim of our study was to retrospectively evaluate the efficacy on improving pregnancy outcomes of having added hydroxychloroquine to conventional treatment in patients who were considered high-risk OAPS.
Methods: We selected 42 patients with OAPS with at least one of the following high-risk factors: triple positivity of aPL and/or history of previous sPE (Table 1). Patients were grouped according to the treatment received and their pregnancy outcomes were compared. Group A (n=30): patients treated with CT: low dose aspirin 100 mg/day + low molecular weight heparin 40 mg/day vs Group B (n=12): patients with CT+ hydroxychloroquine 400 mg/day. A chi-squared test was used to assess the association between sPE and treatment in high-risk OAPS patients (SPSS 23.0).
| Variables | All (n=42) | Group A (n=30) | Group B (n=12) |
| History of previous severe Preeclampsia | 54,7% (23/42) | 60% (18/30) | 41,7% (5/12) |
| History of intrauterine growth restriction | 23,8% (10/42) | 16,7% (5/30) | 41,7% (5/12) |
| Systemic Lupus Erythematosus | 16,7%(7/42) | 16,7% (5/30) | 16,7% (2/12) |
| Triple Positivity aPL | 54,7% (23/42) | 50,0% (15/30) | 66,6% (8/12) |
| Double Positivity aPL | 2,4% (1/42) | 0,0% (0/30) | 8,3% (1/12) |
| Simple Positivity aPL | 42,8% (18/42) | 50,0% (15/30) | 25,0% (3/12) |
| Lupus Anticoagulant | 80,9% (34/42) | 80,0% (24/30) | 83,3% (10/12) |
| aCL High titers (GPL/MPL) x>80 | 35,7% (15/42) | 26,7% (8/30) | 58,3% (7/12) |
| aβ2GPI High titers (UG/UM) x>80 | 38,1% (16/42) | 36,7% (11/30) | 41,7% (5/12) |
[Table 1. Demographic and clinical characteristics of OAPS patients before treatment]
Results: After treatment, the pregnancy outcomes were: Group A: pregnancy loss 16,7% (5/30), sPE 40,0% (12/30), prematurity 26,6% (8/30); Group B: pregnancy loss 8,3% (1/12), sPE 8,3 % (1/12) and prematurity 0,0% (0/12). Patients with CT+HCQ showed significantly lower sPE rates compared with patients with only CT (p=0.03) (Table N°2). Hence, treatment with hydroxychloroquine would be associated with a protective response on preventing sPE, in OAPS patients with high-risk factors.
| Severe Pre-eclampsia | |||
| NO | YES | ||
| Group A (CT) | 18 (60.0%) | 12 (40.0%) | p=0.03 |
| Group B (CT+Hidroxyicloroquine) | 11 (91.7%) | 1 (8.3%) | |
[Table 2. Severe Preeclampsia rates in Group A vs Group B after treatment]
Conclusions: In our cohort, CT was only partially effective in the prevention of sPE. Additional treatment with hydroxychloroquine might benefit OAPS patients with high-risk factors (as triple positivity of aPL and/or history of sPE) by preventing them from developing sPE.
To cite this abstract in AMA style:
Aranda F, Latino JO, Udry S, Perés S, Fernández Romero DS, de Larrañaga G. The Impact of Hydroxychloroquine on the Prevention of Severe Preeclampsia in Patients with Obstetric Anti-Phospholipid Syndrome [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/the-impact-of-hydroxychloroquine-on-the-prevention-of-severe-preeclampsia-in-patients-with-obstetric-anti-phospholipid-syndrome/. Accessed September 21, 2023.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/the-impact-of-hydroxychloroquine-on-the-prevention-of-severe-preeclampsia-in-patients-with-obstetric-anti-phospholipid-syndrome/