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.
|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 December 8, 2021.
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