Clinical characteristics and pregnancy outcomes of non-criteria obstetric antiphospholipid syndrome / 中华内科杂志

Objective:To study clinical characteristics and pregnancy outcomes under anti-coagulation therapy of non-criteria obstetric antiphospholipid syndrome.Methods:Patients suspected of obstetric antiphospholipid syndrome(OAPS) were recruited through Chinese Rheumatism Data Center from 2015 to 2019 consecutively. Patients fulfilling 2006 Sydney revised antiphospholipid syndrome criteria were classified as OAPS. Patients fulfilling definition of non-criteria OAPS(NCOAPS) by expert consensus on diagnosis and management of obstetric antiphospholipid syndrome of China were classified as NCOAPS. Clinical characteristics and laboratory results of two groups were compared. Live birth rates and pregnancy outcomes under anti-coagulation therapy were studied.Results:A total of 88 patients were enrolled, including 56 patients (63.6%) as OAPS, 32(36.4%) as NCOAPS. Live births were only reached in 16.1% (9/56) in OAPS patients and 12.5%(4/32) in NCOAPS. Fetal losses after 10 weeks of gestation and pre-eclampsia before 34 weeks were more common in OAPS group compared to NCOAPS group [78.6%(44/56) vs. 18.8%(6/32), P<0.001; 25.0%(14/56) vs. 3.1%(1/32), P=0.020, respectively]. After enrollment, 15 pregnancies were recorded in OAPS, 10 in NCOAPS, all of whom were treated with low-dose aspirin (LDA) combined with low-molecular weight heparin (LMWH). Live birth rates saw dramatic improvements compared to baseline levels in OAPS [16.1% (9/56) vs. 11/15] along with NCOAPS [12.5% (4/32) vs. 7/10]. Conclusion:Though NCOAPS and OAPS patients differ in antiphospholipid antibody spectrum and pattern of pregnancy morbidities, both groups benefit from LDA combined with LWMH treatment, as live birth rates improve. Non-criteria OAPS patients are recommended to receive anti-coagulation therapy during pregnancy.

The 460th case:lower extremity edema, positive fecal occult blood / 中华内科杂志

An 61-year-old woman presenting deep vein thrombosis and persistent positive anticardiolipin antibodies was diagnosed as antiphospholipid syndrome and treated with low molecular weight heparin. Before and after anticoagulant therapy, continuous positive fecal occult-blood was found asymptomatically. Colonoscopy confirmed rectal cancer. Antiphospholipid autoantibodies are non-specially positive in some malignances, especially in elder onset patients. Thus, routine screening of malignancies is strongly suggested.

The clinical manifestations and thrombotic risk factors in primary antiphospholipid syndrome / 中华内科杂志

Objective To investigate the clinical characteristics in patients with primary antiphospholipid syndrome (PAPS) and to identify potential predictors of thrombotic events.Methods A total of 107 patients with PAPS were enrolled in our study, who were admitted in Peking Union Medical College Hospital from January 2004 to December 2014.Demographic data, age at onset, disease duration, past history of hypertension and regular cigarette smoking, clinical manifestations, imaging characteristics, management and prognosis were retrospectively collected.Bivariate statistical analysis and logistical regression test were performed to compare the discrepancy between patients with or without thromboembolic events.Results In 107 patients, there were 65 female and 42 male patients, with mean age (39.8 ± 15.8) years old, median disease duration 10.5 (2.0, 48.0) months.A total of 72(67.3％) patients reported episodes of thromboembolic events, including 72 venous thromboses and 29 arterial thromboses.The most frequent venous thromboses were deep vein thromboses (35.5％), pulmonary embolism the second common (29.9％), with cranial venous sinus thromboses the following (8.4％).In arterial thromboembolic events, the incidence of transient ischemic attack (TIA) and ischemic stoke was the highest (14.0％), embolism of lower extremities the second (6.5％) ,and 4 patients (3.7％) with acute myocardial infarction.Sixty seven patients (62.6％)had positive lupus anticoagulant, 60 patients (56.1％)with positive anticardiolipin antibody,32 patients (29.9％, 32/74) with positive β2 glycoprotein Ⅰ (β2GP I).Forty patients(37.4％)had double positive antibodies, while 19 cases (17.8％)with triple positive.In logistical regression, aging (per 10 years) and hypocomplementemia were significantly related to venous thrombosis (OR =1.421, 95％ CI 1.066-1.894, P ＜ 0.05, and OR =6.435, 95％ CI 1.374-30.130, P ＜ 0.05, respectively).Cigarette smoking and triple positive antibodies were independent risk factors of arterial thrombosis (OR =3.996, 95％ CI 1.079-14.795, P ＜ 0.05 and OR =3.166, 95％ CI 1.102-9.097, P ＜ 0.05, respectively).Conclusion Alas is an autoimmune disorder characterized by recurrent arterial and venous thromboembolic events.Venous thromboembolism is more common than the arterial.Age and hypocomplementemia are predictors of venous thromboembolism;while smoking and triple positive antibodies are independent risk factors of arterial thromboembolism.