Background The antiphospholipid syndrome is an autoimmune-acquired thrombophilia, the thrombotic manifestations are associated with an important risk of organ damage.1 A new index for assessment of thrombotic accumulative damage in APS has been proposed, it is called Damage Index in patients with Thrombotic Antiphospholipid Syndrome (DIAPS).2
Objectives Explore the DIAPS change in patients with primary and secondary APS in a long-term retrospective cohort.
Methods Clinical records of patients with APS according to the Sapporo3 classification criteria and/or Sydney4 were reviewed. The DIAPS instrument with 38 items was applied. Comparison of the initial and final DIAPS was performed using the Wilcoxon test and the changes in the follow up were analyzed with T Student. The main treatments were analyzed before and after with the NcNemar test.
Results Fifty clinical charts were reviewed, 12 had to be excluded for not fulfill classification criteria or incomplete information. Initial and final DIAPS was recorded in 38 patients (13±5 years of follow up), 78.9% were female, with a mean age at diagnosis 44.2±12.4 years. A total of 57.9% had primary APS. Thirty four patients remain alive with 3 to 23 years of follow up. The initial DIAPS was 3±2 and the final score was 5±3 (p <0.0001). The magnitude of change in the DIAPS was similar in primary and secondary APS (p =0.243). During follow up, 31/38 patients had oral anticoagulation at the beginning and 33/35 at the end (p =0.687). At the beginning of the study hydroxychloroquine was recorded in 14/38 patients and in 24/38 at the end (p =0.021). Aspirin was used by 17/38 patients during the follow up (p =1.000).
Conclusions The change in DIAPS suggests cumulative damage in patients with APS despite treatment. The DIAPS is a useful tool to estimate accrued damage in patients with primary and secondary APS.
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Miyakis S, Lockshin MD, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006 Feb;4(2):295–306.
Disclosure of Interest None declared