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MULTICENTRE
STUDIES
LONG TERM HEALTH
IMPLICATIONS OF PRIMARY ANTIPHOSPHOLIPID ANTIBODY SYNDROME IN WOMEN PRESENTING
WITH RECURRENT MISCARRIAGE – A PROSPECTIVE LONGITUDINAL STUDY
COORDINATORS
Preeti Jindal MD, May
Backos MD, Winnie Lo RCN, Raj Rai MD, Lesley Regan MD (sponsor).
Clinical Obstetrics
and Gynaecology, St Mary’s Hospital, Imperial College London, London W2 1NY,
United Kingdom
PROJECT
Background: Primary antiphospholipid syndrome (PAPS) is
diagnosed in 15 - 20% of women with recurrent miscarriage (RM) - > 3
consecutive pregnancy losses. In
addition to the obstetric implications, PAPS has also been associated with the
development of vascular, dermatological, neurological and haematological
manifestations in later life. However,
the advice that should be offered to RM women who are identified as having
PAPS, regarding their risks of future morbidity are unclear. There are few
published reports on the long term health implications of PAPS and the majority
are retrospective or cross sectional studies recruiting women with recurrent
thrombotic events. This study was designed to overcome the limitations of
available data by recruiting women with RM diagnosed with PAPS to a
prospective, longitudinal follow up programme to assess their long term health
risks.
Objectives: To follow the natural history of PAPS in
women whose first presenting medical symptom is Recurrent Miscarriage. To
determine their frequency of symptomatic venous thrombotic events (VTE),
cerebrovascular accidents (CVA) and other antiphospholipid related clinical
manifestations including the development of systemic lupus erythematosus
(SLE).
Methods: This prospective longitudinal study has been
ongoing since December 1997 based in the Recurrent Miscarriage Clinic at St.
Mary’s Hospital, London. To date 500
women with history of three or more miscarriages, persistently positive tests
for antiphospholipid antibodies and no history of VTE, CVA or SLE have been
invited to complete an initial medical health questionnaire and have been
registered for long term follow up. Of these recruits, 201 women have now
completed 8 years of follow up and their results are presented here.
Results: The median
age of these 201 women at the time of initial diagnosis of PAPS was 34 years
(range 22 – 43 ) and their 8 year follow up period included a total of 947
patient years. The incidence of VTE was
4.2/1000 patient-years, the incidence of CVA was 2.1/1000 patient years and the
incidence of SLE was 1.5/1000 patient-years.
By contrast , the incidence of VTE in an unselected European population
is generally quoted as 0.54/1000 patient-years and for SLE the incidence is
1/1000 patient-years.
Conclusions: The initial results from this
longitudinal study suggest that RM women diagnosed with PAPS are at increased
risk of suffering a VTE, CVA or developing SLE in later life. They should be
counselled accordingly and given advice regarding life style measures aimed at
minimising their risks, such as avoiding smoking, obesity, dehydration and
prolonged immobility. Whether they should all receive low dose aspririn
thromboprophylaxis or be denied future hormonal contraception and post
menopausal hormone replacement is unclear at present. All the VTE’s in this
study cohort occurred subsequent to a further prothrombotic insult such as long
haul travel or major pelvic surgery, suggesting that adequate
thromboprophylaxis should be advised in these circumstances.
For additional
information and applications, please e-mail: l.regan@imperial.ac.uk
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Last updated: 17 November 2005 |
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