Pregnant patients with antiphospholipid syndrome may benefit from addition of aspirin to treatment

MADRID — Pregnant patients with antiphospholipid syndrome managed with conventional treatments appear to have a high level of obstetrical complications and may benefit from the addition of aspirin to their regimen, according to a study presented at the EULAR Annual Congress.

“We report a high level of obstetrical complication in these patients, despite treatment,” presenter Cecile M. Yelnik, MD, said. “We also found a beneficial effect of adding aspirin to prevent obstetric morbidity. Heparin and aspirin were well tolerated and did not increase risk of hemorrhage. A therapeutic trial is needed to confirm the safety profile.”

Yelnik and colleagues evaluated 264 pregnancies (87 collected prospectively) of 204 patients with antiphospholipid syndrome. Data were collected from two cohorts: a prospective cohort from the PROMISSE study (n=87) and a retrospective cohort culled from four tertiary centers in France (n=117). Of the patients evaluated, 46% had a history of thrombosis and 23% had associated systemic lupus erythematosus. Patients were treated during their pregnancies with heparin (n=253) and low-dose aspirin (n=223).

The primary outcome was the occurrence of adverse pregnancy outcomes (APOs), which included the following: fetal death or neonatal death; pre-term delivery prior to 36 weeks at gestation due to preeclampsia or placental insufficiency; or small for gestational age. Blood loss greater than 500 mL and or/necessitating surgery or transfusion was defined as major bleeding.

The researchers found the live birth rate was 86%. Overall, APOs were seen in 32%, primarily during the second trimester. The following APOs occurred: fetal deaths, 11%; small gestational age, 11%; pre-term delivery before 36 weeks at gestation due to preeclampsia or placental insufficiency, 17%.

There were 13 maternal thrombotic events in 12 (4.5%) pregnancies.

In 40 (15%) pregnancies, 46 maternal hemorrhagic events were reported; 30 of these events occurred in the post-partum period. Six pregnancies (2.3%) incurred major bleeding, and this bleeding occurred only after delivery. With the exception of two bleeding events, postpartum hemorrhage was reported in the early postpartum period, prior to discharge from the hospital. There were no maternal deaths.

In a multivariate analysis, the researchers identified aspirin therapy during pregnancy as the only independent factor linked to a reduced risk of APOs (odds ratio: 0.34).
increased by heparin or aspirin monotherapy, or by combined aspirin/heparin therapy. In the retrospective cohort, the only factor associated with hemorrhagic events during the study interval was emergency caesarian section (53% hemorrhages in patients who underwent emergency caesarian section vs. 18% in those without caesarian section). High BMI and the presence of lupus anticoagulant were identified as independent risk factors for APOs. – by Jennifer Byrne

Reference:

Yelnik CM, et al. Abstract #OP0236. Presented at: Presented at: EULAR Annual Congress; June 14-17, 2017; Madrid.

Disclosure: The researchers report no relevant disclosures.