Morbidity and mortality in the antiphospholipid syndrome during a 5-year period: A multicentre prospective study of 1000 patients

R. Cervera, M. A. Khamashta, Y. Shoenfeld, M. T. Camps, S. Jacobsen, E. Kiss, M. M. Zeher, A. Tincani, I. Kontopoulou-Griva, M. Galeazzi, F. Bellisai, P. L. Meroni, R. H W M Derksen, P. G. De Groot, E. Gromnica-Ihle, M. Baleva, M. Mosca, S. Bombardieri, F. Houssiau, J. C. GrisI. Quéré, E. Hachulla, C. Vasconcelos, B. Roch, A. Fernández-Nebro, J. C. Piette, G. Espinosa, S. Bucciarelli, C. N. Pisoni, M. L. Bertolaccini, M. C. Boffa, G. R V Hughes

Research output: Contribution to journalArticle

Abstract

Objectives: To identify the main causes of morbidity and mortality in patients with antiphospholipid syndrome (APS) during a 5-year period and to determine clinical and immunological parameters with prognostic significance. Methods: The clinical and immunological features of a cohort of 1000 patients with APS from 13 European countries who had been followed up from 1999 to 2004 were analysed. Results: 200 (20%) patients developed APS-related manifestations during the 5-year study period. Recurrent thrombotic events appeared in 166 (16.6%) patients and the most common were strokes (2.4% of the total cohort), transient ischaemic attacks (2.3%), deep vein thromboses (2.1%) and pulmonary embolism (2.1%). When the thrombotic events occurred, 90 patients were receiving oral anticoagulants and 49 were using aspirin. 31/420 (7.4%) patients receiving oral anticoagulants presented with haemorrhage. 3/121 (2.5%) women with only obstetric APS manifestations at the start of the study developed a new thrombotic event. A total of 77 women (9.4% of the female patients) had one or more pregnancies and 63 (81.8% of pregnant patients) had one or more live births. The most common fetal complications were early pregnancy loss (17.1% of pregnancies) and premature birth (35% of live births). 53 (5.3% of the total cohort) patients died. The most common causes of death were bacterial infection (21% of deaths), myocardial infarction (19%) and stroke (13%). No clinical or immunological predictor of thrombotic events, pregnancy morbidity or mortality was detected. Conclusion: Patients with APS still develop significant morbidity and mortality despite current treatment (oral anticoagulants or antiaggregants, or both).

Original languageEnglish
Pages (from-to)1428-1432
Number of pages5
JournalAnnals of the Rheumatic Diseases
Volume68
Issue number9
DOIs
Publication statusPublished - Sep 2009

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Antiphospholipid Syndrome
Anticoagulants
Multicenter Studies
Prospective Studies
Morbidity
Mortality
Obstetrics
Aspirin
Pregnancy
Live Birth
Stroke
Transient Ischemic Attack
Premature Birth
Pulmonary Embolism
Bacterial Infections
Venous Thrombosis
Cause of Death
Myocardial Infarction
Hemorrhage

ASJC Scopus subject areas

  • Rheumatology
  • Immunology
  • Biochemistry, Genetics and Molecular Biology(all)
  • Immunology and Allergy

Cite this

Cervera, R., Khamashta, M. A., Shoenfeld, Y., Camps, M. T., Jacobsen, S., Kiss, E., ... Hughes, G. R. V. (2009). Morbidity and mortality in the antiphospholipid syndrome during a 5-year period: A multicentre prospective study of 1000 patients. Annals of the Rheumatic Diseases, 68(9), 1428-1432. https://doi.org/10.1136/ard.2008.093179

Morbidity and mortality in the antiphospholipid syndrome during a 5-year period : A multicentre prospective study of 1000 patients. / Cervera, R.; Khamashta, M. A.; Shoenfeld, Y.; Camps, M. T.; Jacobsen, S.; Kiss, E.; Zeher, M. M.; Tincani, A.; Kontopoulou-Griva, I.; Galeazzi, M.; Bellisai, F.; Meroni, P. L.; Derksen, R. H W M; De Groot, P. G.; Gromnica-Ihle, E.; Baleva, M.; Mosca, M.; Bombardieri, S.; Houssiau, F.; Gris, J. C.; Quéré, I.; Hachulla, E.; Vasconcelos, C.; Roch, B.; Fernández-Nebro, A.; Piette, J. C.; Espinosa, G.; Bucciarelli, S.; Pisoni, C. N.; Bertolaccini, M. L.; Boffa, M. C.; Hughes, G. R V.

In: Annals of the Rheumatic Diseases, Vol. 68, No. 9, 09.2009, p. 1428-1432.

Research output: Contribution to journalArticle

Cervera, R, Khamashta, MA, Shoenfeld, Y, Camps, MT, Jacobsen, S, Kiss, E, Zeher, MM, Tincani, A, Kontopoulou-Griva, I, Galeazzi, M, Bellisai, F, Meroni, PL, Derksen, RHWM, De Groot, PG, Gromnica-Ihle, E, Baleva, M, Mosca, M, Bombardieri, S, Houssiau, F, Gris, JC, Quéré, I, Hachulla, E, Vasconcelos, C, Roch, B, Fernández-Nebro, A, Piette, JC, Espinosa, G, Bucciarelli, S, Pisoni, CN, Bertolaccini, ML, Boffa, MC & Hughes, GRV 2009, 'Morbidity and mortality in the antiphospholipid syndrome during a 5-year period: A multicentre prospective study of 1000 patients', Annals of the Rheumatic Diseases, vol. 68, no. 9, pp. 1428-1432. https://doi.org/10.1136/ard.2008.093179
Cervera, R. ; Khamashta, M. A. ; Shoenfeld, Y. ; Camps, M. T. ; Jacobsen, S. ; Kiss, E. ; Zeher, M. M. ; Tincani, A. ; Kontopoulou-Griva, I. ; Galeazzi, M. ; Bellisai, F. ; Meroni, P. L. ; Derksen, R. H W M ; De Groot, P. G. ; Gromnica-Ihle, E. ; Baleva, M. ; Mosca, M. ; Bombardieri, S. ; Houssiau, F. ; Gris, J. C. ; Quéré, I. ; Hachulla, E. ; Vasconcelos, C. ; Roch, B. ; Fernández-Nebro, A. ; Piette, J. C. ; Espinosa, G. ; Bucciarelli, S. ; Pisoni, C. N. ; Bertolaccini, M. L. ; Boffa, M. C. ; Hughes, G. R V. / Morbidity and mortality in the antiphospholipid syndrome during a 5-year period : A multicentre prospective study of 1000 patients. In: Annals of the Rheumatic Diseases. 2009 ; Vol. 68, No. 9. pp. 1428-1432.
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abstract = "Objectives: To identify the main causes of morbidity and mortality in patients with antiphospholipid syndrome (APS) during a 5-year period and to determine clinical and immunological parameters with prognostic significance. Methods: The clinical and immunological features of a cohort of 1000 patients with APS from 13 European countries who had been followed up from 1999 to 2004 were analysed. Results: 200 (20{\%}) patients developed APS-related manifestations during the 5-year study period. Recurrent thrombotic events appeared in 166 (16.6{\%}) patients and the most common were strokes (2.4{\%} of the total cohort), transient ischaemic attacks (2.3{\%}), deep vein thromboses (2.1{\%}) and pulmonary embolism (2.1{\%}). When the thrombotic events occurred, 90 patients were receiving oral anticoagulants and 49 were using aspirin. 31/420 (7.4{\%}) patients receiving oral anticoagulants presented with haemorrhage. 3/121 (2.5{\%}) women with only obstetric APS manifestations at the start of the study developed a new thrombotic event. A total of 77 women (9.4{\%} of the female patients) had one or more pregnancies and 63 (81.8{\%} of pregnant patients) had one or more live births. The most common fetal complications were early pregnancy loss (17.1{\%} of pregnancies) and premature birth (35{\%} of live births). 53 (5.3{\%} of the total cohort) patients died. The most common causes of death were bacterial infection (21{\%} of deaths), myocardial infarction (19{\%}) and stroke (13{\%}). No clinical or immunological predictor of thrombotic events, pregnancy morbidity or mortality was detected. Conclusion: Patients with APS still develop significant morbidity and mortality despite current treatment (oral anticoagulants or antiaggregants, or both).",
author = "R. Cervera and Khamashta, {M. A.} and Y. Shoenfeld and Camps, {M. T.} and S. Jacobsen and E. Kiss and Zeher, {M. M.} and A. Tincani and I. Kontopoulou-Griva and M. Galeazzi and F. Bellisai and Meroni, {P. L.} and Derksen, {R. H W M} and {De Groot}, {P. G.} and E. Gromnica-Ihle and M. Baleva and M. Mosca and S. Bombardieri and F. Houssiau and Gris, {J. C.} and I. Qu{\'e}r{\'e} and E. Hachulla and C. Vasconcelos and B. Roch and A. Fern{\'a}ndez-Nebro and Piette, {J. C.} and G. Espinosa and S. Bucciarelli and Pisoni, {C. N.} and Bertolaccini, {M. L.} and Boffa, {M. C.} and Hughes, {G. R V}",
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TY - JOUR

T1 - Morbidity and mortality in the antiphospholipid syndrome during a 5-year period

T2 - A multicentre prospective study of 1000 patients

AU - Cervera, R.

AU - Khamashta, M. A.

AU - Shoenfeld, Y.

AU - Camps, M. T.

AU - Jacobsen, S.

AU - Kiss, E.

AU - Zeher, M. M.

AU - Tincani, A.

AU - Kontopoulou-Griva, I.

AU - Galeazzi, M.

AU - Bellisai, F.

AU - Meroni, P. L.

AU - Derksen, R. H W M

AU - De Groot, P. G.

AU - Gromnica-Ihle, E.

AU - Baleva, M.

AU - Mosca, M.

AU - Bombardieri, S.

AU - Houssiau, F.

AU - Gris, J. C.

AU - Quéré, I.

AU - Hachulla, E.

AU - Vasconcelos, C.

AU - Roch, B.

AU - Fernández-Nebro, A.

AU - Piette, J. C.

AU - Espinosa, G.

AU - Bucciarelli, S.

AU - Pisoni, C. N.

AU - Bertolaccini, M. L.

AU - Boffa, M. C.

AU - Hughes, G. R V

PY - 2009/9

Y1 - 2009/9

N2 - Objectives: To identify the main causes of morbidity and mortality in patients with antiphospholipid syndrome (APS) during a 5-year period and to determine clinical and immunological parameters with prognostic significance. Methods: The clinical and immunological features of a cohort of 1000 patients with APS from 13 European countries who had been followed up from 1999 to 2004 were analysed. Results: 200 (20%) patients developed APS-related manifestations during the 5-year study period. Recurrent thrombotic events appeared in 166 (16.6%) patients and the most common were strokes (2.4% of the total cohort), transient ischaemic attacks (2.3%), deep vein thromboses (2.1%) and pulmonary embolism (2.1%). When the thrombotic events occurred, 90 patients were receiving oral anticoagulants and 49 were using aspirin. 31/420 (7.4%) patients receiving oral anticoagulants presented with haemorrhage. 3/121 (2.5%) women with only obstetric APS manifestations at the start of the study developed a new thrombotic event. A total of 77 women (9.4% of the female patients) had one or more pregnancies and 63 (81.8% of pregnant patients) had one or more live births. The most common fetal complications were early pregnancy loss (17.1% of pregnancies) and premature birth (35% of live births). 53 (5.3% of the total cohort) patients died. The most common causes of death were bacterial infection (21% of deaths), myocardial infarction (19%) and stroke (13%). No clinical or immunological predictor of thrombotic events, pregnancy morbidity or mortality was detected. Conclusion: Patients with APS still develop significant morbidity and mortality despite current treatment (oral anticoagulants or antiaggregants, or both).

AB - Objectives: To identify the main causes of morbidity and mortality in patients with antiphospholipid syndrome (APS) during a 5-year period and to determine clinical and immunological parameters with prognostic significance. Methods: The clinical and immunological features of a cohort of 1000 patients with APS from 13 European countries who had been followed up from 1999 to 2004 were analysed. Results: 200 (20%) patients developed APS-related manifestations during the 5-year study period. Recurrent thrombotic events appeared in 166 (16.6%) patients and the most common were strokes (2.4% of the total cohort), transient ischaemic attacks (2.3%), deep vein thromboses (2.1%) and pulmonary embolism (2.1%). When the thrombotic events occurred, 90 patients were receiving oral anticoagulants and 49 were using aspirin. 31/420 (7.4%) patients receiving oral anticoagulants presented with haemorrhage. 3/121 (2.5%) women with only obstetric APS manifestations at the start of the study developed a new thrombotic event. A total of 77 women (9.4% of the female patients) had one or more pregnancies and 63 (81.8% of pregnant patients) had one or more live births. The most common fetal complications were early pregnancy loss (17.1% of pregnancies) and premature birth (35% of live births). 53 (5.3% of the total cohort) patients died. The most common causes of death were bacterial infection (21% of deaths), myocardial infarction (19%) and stroke (13%). No clinical or immunological predictor of thrombotic events, pregnancy morbidity or mortality was detected. Conclusion: Patients with APS still develop significant morbidity and mortality despite current treatment (oral anticoagulants or antiaggregants, or both).

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