Clinical study and follow-up of 100 patients with the antiphospholipid syndrome

Objectives: To study the clinical characteristics at diagnosis and during f ollow-up of patients with the antiphospholipid syndrome (APS) and to analyz e the influence of treatment on their outcome. Patients: One hundred patients with APS were included (86% female and 14% m ale; mean age, 36 years). Sixty-two percent had primary APS and 38% had APS associated with systemic lupus erythematosus (SLE). The median length of f ollow-up was 49 months. Results: Fifty-three percent of the patients had thromboses, 52% had thromb ocytopenia, and 60% of the women had pregnancy losses. Patients with APS as sociated with SLE had a higher prevalence of hemolytic anemia (P =.02), thr ombocytopenia (platelet count lower than 100 x 10(9)/L) (P=.004), antinucle ar antibodies (P =.0002), and low complement levels, Fifty-three percent of the patients with thrombosis had recurrent episodes (86% in the same site as the previous thrombotic event). Recurrences were observed in 19% of the episodes treated with long-term oral anticoagulation, in 42% treated prophy lactically with aspirin, and in 91% in which anticoagulant/antiaggregant tr eatment was discontinued (P =.0007). Multivariate analysis showed that prop hylactic treatment and older age had an independent predictive value for re thrombosis. Prophylactic treatment during pregnancy (usually with aspirin) increased the live birth rate from 38% to 72% (P =.0002). Conclusions: Patients with APS have a high risk of recurrent thromboses. Lo ng-term oral anticoagulation seems to be the best prophylactic treatment to prevent recurrences. Prophylactic treatment with aspirin during pregnancy reduced the rate of miscarriages remarkably Copyright (C) 1999 by W.B. Saun ders Company.