Rhein Ariel Katherine, Rabinovich Anat, Abuhasira Ran, Lubaton-Barshishat Shir, Erez Offer
The Joyce & Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Thrombosis and Hemostasis Unit, Hematology Institute, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Res Pract Thromb Haemost. 2024 Apr 29;8(4):102430. doi: 10.1016/j.rpth.2024.102430. eCollection 2024 May.
Antiphospholipid syndrome (APS) can present with either a thromboembolic event (thrombotic APS, TAPS) or an obstetric complication (obstetric APS, OAPS). Data on long-term complications in the different APS phenotypes are limited.
We aimed to compare obstetric history, antiphospholipid antibody profiles, obstetric and thromboembolic complications, and pregnancy outcomes between TAPS and OAPS.
This retrospective cohort study included women who delivered singleton pregnancies between 1998 and 2020. One hundred sixteen thousand four hundred nine women were included, resulting in 320,455 deliveries. Among the included patients, 71 were diagnosed with APS, 49 were classified as OAPS, and 22 as TAPS. The demographics, obstetric, neonatal, and thrombotic outcomes were compared among TAPS, OAPS, and the general obstetric population.
OAPS patients had an increased risk of thrombotic events compared with the general obstetric population (odds ratio [OR] 18.0; 95% CI, 8.7-37.2). In pregnancies following the diagnosis of APS, despite standard antithrombotic treatment, OAPS patients exhibited an elevated risk of placenta-related and neonatal complications compared with the general obstetric population (late fetal loss [adjusted OR {aOR}, 15.3; 95% CI, 0.5-27.5], stillbirth [aOR, 5.9; 95% CI, 2.2-15.4], placental abruption [aOR, 4.8; 95% CI, 1.5-15.3], preeclampsia [aOR, 4.4; 95% CI, 2.5-7.7], fetal growth restriction [aOR, 4.3; 95% CI, 8.5-27.5], small for gestational age neonate [aOR, 4.0; 95% CI, 2.4-6.6], and low Apgar scores [Apgar'1: aOR, 2.6; 95% CI, 1.3-10.4; Apgar'5: aOR, 3.7; 95% CI, 1.3-10.4]). TAPS patients exhibited increased risk of preeclampsia (aOR, 3.1; 95% CI, 1.2-8).
OAPS patients exhibit a heightened risk of thrombotic events compared with the general obstetric population. Despite treatment, OAPS and TAPS still presented obstetric complications. These findings, after confirmation in prospective studies, need to be taken into consideration when planning the treatment approach for these patients.
抗磷脂综合征（APS）可表现为血栓栓塞事件（血栓性APS，TAPS）或产科并发症（产科APS，OAPS）。关于不同APS表型的长期并发症的数据有限。
我们旨在比较TAPS和OAPS之间的产科病史、抗磷脂抗体谱、产科和血栓栓塞并发症以及妊娠结局。
这项回顾性队列研究纳入了1998年至2020年间分娩单胎妊娠的女性。共纳入116409名女性，分娩320455次。在纳入的患者中，71例被诊断为APS，49例归类为OAPS，22例归类为TAPS。比较了TAPS、OAPS和一般产科人群的人口统计学、产科、新生儿和血栓形成结局。
与一般产科人群相比，OAPS患者发生血栓事件的风险增加（优势比[OR]18.0；95%CI，8.7 - 37.2）。在诊断为APS后的妊娠中，尽管进行了标准的抗血栓治疗，但与一般产科人群相比，OAPS患者发生胎盘相关和新生儿并发症的风险升高（晚期胎儿丢失[调整后OR{aOR}，15.3；95%CI，0.5 - 27.5]，死产[aOR，5.9；95%CI，2.2 - 15.4]，胎盘早剥[aOR，4.8；95%CI，1.5 - 15.3]，子痫前期[aOR，4.4；95%CI，2.5 - 7.7]，胎儿生长受限[aOR，4.3；95%CI，8.5 - 27.5]，小于胎龄儿[aOR，4.0；95%CI，2.4 - 6.6]，以及低Apgar评分[1分钟Apgar评分：aOR，2.6；95%CI，1.3 - 10.4；5分钟Apgar评分：aOR，3.7；95%CI，1.3 - 10.4]）。TAPS患者发生子痫前期的风险增加（aOR，3.1；95%CI，1.2 - 8）。
与一般产科人群相比，OAPS患者发生血栓事件的风险更高。尽管进行了治疗，OAPS和TAPS仍存在产科并发症。这些发现在前瞻性研究得到证实后，在为这些患者制定治疗方案时需要予以考虑。
