Clinical study and follow-up of 100 patients with the antiphospholipid syndrome

被引:90
作者
Muñoz-Rodriguez, FJ
Font, J
Cervera, R
Reverter, JC
Tàssies, D
Espinosa, G
López-Soto, A
Carmona, F
Balasch, J
Ordinas, A
Ingelmo, M
机构
[1] Hosp Clin Barcelona, Syst Autoimmune Dis Unit, Dept Hemotherapy & Hemostasis, E-08036 Barcelona, Spain
[2] Hosp Clin Barcelona, Dept Obstet & Gynecol, Inst Invest Biomed August Pi & Sunyer, IDIBAPS, E-08036 Barcelona, Spain
关键词
antiphospholipid syndrome; thrombosis; obstetric complications; prophylactic treatment;
D O I
10.1016/S0049-0172(99)80029-8
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives: To study the clinical characteristics at diagnosis and during follow-up of patients with the antiphospholipid syndrome (APS) and to analyze the influence of treatment on their outcome. Patients: One hundred patients with APS were included (86% female and 14% male; mean age, 36 years). Sixty-two percent had primary APS and 38% had APS associated with systemic lupus erythematosus (SLE). The median length of follow-up was 49 months. Results: Fifty-three percent of the patients had thromboses, 52% had thrombocytopenia, and 60% of the women had pregnancy losses. Patients with APS associated with SLE had a higher prevalence of hemolytic anemia (P =.02), thrombocytopenia (platelet count lower than 100 x 10(9)/L) (P=.004), antinuclear antibodies (P =.0002), and low complement levels, Fifty-three percent of the patients with thrombosis had recurrent episodes (86% in the same site as the previous thrombotic event). Recurrences were observed in 19% of the episodes treated with long-term oral anticoagulation, in 42% treated prophylactically with aspirin, and in 91% in which anticoagulant/antiaggregant treatment was discontinued (P =.0007). Multivariate analysis showed that prophylactic treatment and older age had an independent predictive value for rethrombosis. Prophylactic treatment during pregnancy (usually with aspirin) increased the live birth rate from 38% to 72% (P =.0002). Conclusions: Patients with APS have a high risk of recurrent thromboses. Long-term oral anticoagulation seems to be the best prophylactic treatment to prevent recurrences. Prophylactic treatment with aspirin during pregnancy reduced the rate of miscarriages remarkably Copyright (C) 1999 by W.B. Saunders Company.
引用
收藏
页码:182 / 190
页数:9
相关论文
共 39 条
[1]   THE PRIMARY ANTIPHOSPHOLIPID SYNDROME - MAJOR CLINICAL AND SEROLOGICAL FEATURES [J].
ASHERSON, RA ;
KHAMASHTA, MA ;
ORDIROS, J ;
DERKSEN, RHWM ;
MACHIN, SJ ;
BARQUINERO, J ;
OUTT, HH ;
HARRIS, EN ;
VILARDELLTORRES, M ;
HUGHES, GRV .
MEDICINE, 1989, 68 (06) :366-374
[2]  
Brandt JT, 1995, THROMB HAEMOSTASIS, V74, P1597
[3]   CLINICOPATHOLOGICAL CORRELATIONS OF THE ANTIPHOSPHOLIPID SYNDROME [J].
CERVERA, R ;
ASHERSON, RA ;
LIE, JT .
SEMINARS IN ARTHRITIS AND RHEUMATISM, 1995, 24 (04) :262-272
[4]   SYSTEMIC LUPUS-ERYTHEMATOSUS - CLINICAL AND IMMUNOLOGICAL PATTERNS OF DISEASE EXPRESSION IN A COHORT OF 1,000 PATIENTS [J].
CERVERA, R ;
KHAMASHTA, MA ;
FONT, J ;
SEBASTIANI, GD ;
GIL, A ;
LAVILLA, P ;
DOMENECH, I ;
AYDINTUG, AO ;
JEDRYKAGORAL, A ;
DERAMON, E ;
GALEAZZI, M ;
HAGA, HJ ;
MATHIEU, A ;
HOUSSIAU, F ;
INGELMO, M ;
HUGHES, GRV ;
CERVERA, R ;
SEBASTIANI, GD ;
FONT, J ;
KHAMASHTA, MA ;
HUGHES, GRV ;
FONT, J ;
CERVERA, R ;
LOPEZSOTO, A ;
VIVANCOS, J ;
INGELMO, M ;
URBANOMARQUEZ, A ;
KHAMASHTA, MA ;
VIANNA, J ;
HUGHES, GRV ;
GIL, A ;
LAVILLA, P ;
PINTADO, V ;
LOPEZDUPLA, M ;
VAZQUEZ, JJ ;
SEBASTIANI, GD ;
DERAMON, E ;
CAMPS, M ;
FRUTOS, MA ;
PERELLO, I ;
SANTOS, PG ;
ABARCA, M ;
NEBRO, AF ;
DOMENECH, I ;
TOKGOZ, G ;
AYDINTUG, AO ;
JEDRYKAGORAL, A ;
MALDYKOWA, H ;
CHWALINSKASADOWSKA, H ;
GALEAZZI, M .
MEDICINE, 1993, 72 (02) :113-124
[5]   REPEATED FETAL LOSSES ASSOCIATED WITH ANTIPHOSPHOLIPID ANTIBODIES - A COLLABORATIVE RANDOMIZED TRIAL COMPARING PREDNISONE WITH LOW-DOSE HEPARIN TREATMENT [J].
COWCHOCK, FS ;
REECE, EA ;
BALABAN, D ;
BRANCH, DW ;
PLOUFFE, L .
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 1992, 166 (05) :1318-1323
[6]  
DELEZE M, 1989, J RHEUMATOL, V16, P926
[7]  
DellaValle P, 1996, ANN MED INTERNE, V147, P10
[8]   Clinical manifestations and management of the antiphospholipid syndrome [J].
Derksen, RHWM .
LUPUS, 1996, 5 (02) :167-169
[9]  
FABRIS F, 1994, EUR J HAEMATOL, V53, P232
[10]   PREVENTION OF FETAL LOSS IN EXPERIMENTAL ANTIPHOSPHOLIPID SYNDROME BY INVIVO ADMINISTRATION OF RECOMBINANT INTERLEUKIN-3 [J].
FISHMAN, P ;
FALACHVAKNINE, E ;
ZIGELMAN, R ;
BAKIMER, R ;
SREDNI, B ;
DJALDETTI, M ;
SHOENFELD, Y .
JOURNAL OF CLINICAL INVESTIGATION, 1993, 91 (04) :1834-1837