Background The clinical evolution of antiphospholipid syndrome (APS) is diverse. Complications and comorbidities related to treatment and to the illness itself may vary and could depend on the type of population. However the impact of comorbidities and complications on the illness itself is little know.
Objectives Objective: To describe the clinical evolution and complications of primary APS patients and the role of comorbidities in the clinical evolution of primary APS
Methods Patients and Methods: We included patients with established diagnosis of primary APS (Sidney criteria), 16 years of age and older, both genders and at least one year of evolution from a cohort of patients. We obtained demographic, clinical and laboratory data from medical files including disease evolution, ± number of thrombotic events, complications and the presence of comorbidities: dyslipidemia, obesity, arterial hypertension and diabetes mellitus. We employed descriptive statistics and chi-square.
Results Results: We included 72 patients with primary APS, 57 females and 15 males, mean age 44±12.7 years (range 18 to 77 years) disease evolution 10.5±5.9 years (range 1 to 23 years). The comorbidity most frequently found was dyslipidemia in 29 patients characterized by hypertriglyceridemia and low levels of HDL, followed by obesity and arterial hypertension in 14 patients and diabetes mellitus in 7.Two patients presented the highest number of thrombotic recurrences (13).The most frequent thrombotic manifestations were deep vein thrombosis in 25, pulmonary embolism in 16, and stroke in 16. Obstetric manifestations: 24 patients had abortion, 20 with fetal loss, 4 patients had only obstetric manifestations without thrombosis. Anticoagulant treatment: 66 patients (mean INR 2.2) and 6 with aspirin alone. Complications secondary to APS: 12 patients with postphlebitic sequelae, 6 with stroke sequelae, 2 with amputation of extremities, 3 with optic neuritis sequelae. Complications related to anticoagulant treatment: only 3 patients required hospitalization for bleeding, 14 patients had minor hemorrhagic events that did not require hospitalization. One patient had catastrophic PAS. Hyperlipidemia was significantly associated with venous recurrent thrombosis and postphlebitic sequelae (p<0.001).
Conclusions This study shows for first time that hyperlipidemia (hypertriglyceridemia and low levels of HDL) is associated with recurrent thrombosis and postphlebitic sequelae. Comorbidities are frequent in APS patients along the evolution and may contribute to the complications. Complications may present even in patients with long-term anticoagulation, suggesting that other therapeutic strategies are necessary.
Vayá A, Mira Y, Ferrando F, Contreras M, Estelles A, España F, Corella D, Aznar J. Hyperlipidaemia and venous thromboembolism in patients lacking thrombophilic risk factors. Br J Haematol. 2002 Jul;118(1):255-9
Disclosure of Interest None declared