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Morbidity and mortality in the antiphospholipid syndrome during a 5-year period: a multicenter prospective study of 1,000 patients
  1. Ricard Cervera (rcervera{at}clinic.ub.es)
  1. Hospital Clinic, Barcelona, Spain
    1. Munther A Khamashta
    1. St Thomas' Hospital, London, United Kingdom
      1. Yehuda Shoenfeld
      1. Chaim-Sheba Medical Center, Tel-Hashomer, Israel
        1. María Teresa Camps
        1. Hospital Carlos Haya, Malaga, Spain
          1. Soren Jacobsen
          1. Copenhagen University, Denmark
            1. Emese Kiss
            1. University of Debrecen, Hungary
              1. Margit M Zeher
              1. University of Debrecen, Hungary
                1. Angela Tincani
                1. Spedali Civile de Brescia, Italy
                  1. Irene Kontopoulou-Griva
                  1. Hippocration Hospital, Athens, Greece
                    1. Mauro Galeazzi
                    1. Policlinico Le Scotte, Siena, Italy
                      1. Francesca Bellisai
                      1. Policlinico Le Scotte, Siena, Italy
                        1. Pier Luigi Meroni
                        1. Univeristà di Milano, Italy
                          1. Ronald HWM Derksen
                          1. Utrecht University, Netherlands
                            1. Philip G de Groot
                            1. Utrecht University, Netherlands
                              1. Erika Gromnica-Ihle
                              1. Immanuel-Krankenhaus, Berlin, Germany
                                1. Marta Baleva
                                1. Medical University, Sofia, Bulgaria
                                  1. Marta Mosca
                                  1. Università di Pisa, Italy
                                    1. Stefano Bombardieri
                                    1. Università di Pisa, Italy
                                      1. Frédéric Houssiau
                                      1. Université Catholique de Louvaine, Brussels, Belgium
                                        1. Jean Christophe Gris
                                        1. CHU Nimes, France
                                          1. Isabelle Quéré
                                          1. CHU Nimes, France
                                            1. Eric Hachulla
                                            1. Hôpital Claude Huriez, Lille, France
                                              1. Carlos Vasconcelos
                                              1. Hospital San António, Porto, Portugal
                                                1. Beate Roch
                                                1. University of Dresden, Germany
                                                  1. Antonio Fernandez-Nebro
                                                  1. Hospital Carlos Haya, Malaga, Spain
                                                    1. Jean Charles Piette
                                                    1. Hôpital Pitié-Salpetrière, Paris, France
                                                      1. Gerard Espinosa
                                                      1. Hospital Clinic, Barcelona, Spain
                                                        1. Silvia Bucciarelli
                                                        1. Hospital Clinic, Barcelona, Spain
                                                          1. Cecilia N Pisoni
                                                          1. St Thomas' Hospital, London, United Kingdom
                                                            1. Maria Laura Bertolaccini
                                                            1. St Thomas' Hospital, London, United Kingdom
                                                              1. Marie Claire Boffa
                                                              1. Hôpital Pitié-Salpetrière, Paris, France
                                                                1. Graham RV Hughes
                                                                1. St Thomas' Hospital, London, United Kingdom

                                                                  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 immunologic parameters with prognostic significance.

                                                                  Methods: We analyzed the clinical and immunologic features of a cohort of 1,000 patients with APS from 13 European countries that have been followed from 1999 to 2004.

                                                                  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 ischemic attacks (2.3%), deep vein thromboses (2.1%), and pulmonary embolism (2.1%). When the thrombotic events occurred, 90 patients were on oral anticoagulants and 49 were using aspirin. 31 out of 420 (7.4%) patients on oral anticoagulants presented with hemorrhage. 3 out of 121 (2.5%) women with only obstetric APS manifestations at the beginning of the study developed a new thrombotic event. A total of 77 women (9.4% of female patients) experienced one or more pregnancies and 63 (81.8% of pregnant patients) succeeded in having 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 frequent causes of death were bacterial infection (21% of deaths), myocardial infarction (19%), and stroke (13%). No clinical or immunologic predictor of thrombotic events, pregnancy morbidity or mortality was detected.

                                                                  Conclusion: APS patients still develop significant morbidity and mortality despite current therapy (oral anticoagulants and/or antiaggregants).

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