Precipitating factors of catastrophic antiphospholipid syndrome: the role of anticoagulant treatment in a series of 112 patients.

Pregnancy Female Male Humans Antiphospholipid Syndrome / complications Anticoagulants / adverse effects Precipitating Factors Retrospective Studies Lupus Erythematosus, Systemic
anticoagulant antiphospholipid antibodies antiphospholipid syndrome autoimmune diseases catastrophic antiphospholipid syndrome

Journal

Journal of thrombosis and haemostasis : JTH
ISSN: 1538-7836
Titre abrégé: J Thromb Haemost
Pays: England
ID NLM: 101170508

Informations de publication

Date de publication:
05 2023
Historique:
received: 08 09 2022
revised: 31 01 2023
accepted: 07 02 2023
medline: 2 5 2023
pubmed: 16 2 2023
entrez: 15 2 2023
Statut: ppublish

Résumé

The prevention of catastrophic antiphospholipid syndrome (CAPS), a rare complication of antiphospholipid syndrome (APS), is a major goal. We analyzed its precipitating factors, focusing on anticoagulation immediately before CAPS episodes. We retrospectively analyzed patients in the French multicenter APS/systemic lupus erythematosus database with at least 1 CAPS episode. Then we compared each patient with known APS before CAPS with 2 patients with non-CAPS APS matched for age, sex, center, and APS phenotype. We included 112 patients with CAPS (70% women; mean age, 43 ± 15 years). At least 1 standard precipitating factor of CAPS was observed for 67 patients (64%), which were mainly infections (n = 28, 27%), pregnancy (n = 23, 22%), and surgery (n = 16, 15%). Before the CAPS episode, 67 (60%) patients already had a diagnosis of APS. Of the 61 treated with anticoagulants, 32 (48%) received vitamin K antagonists (VKAs), 23 (34%) heparin, and 2 (3%) a direct oral anticoagulant. They were less likely than their matched patients with APS without CAPS to receive VKA (48% vs 66%, p = .001). Among those treated with VKA, 72% had a subtherapeutic international normalized ratio (ie, <2) versus 28% in patients with APS without CAPS (p < .001). Finally, excluding pregnant patients (n = 14) for whom we could not differentiate the effect of treatment from that of pregnancy, we were left with 47 cases, 32 (68%) of whom had recently begun a direct oral anticoagulant, planned bridging therapy, or had VKA treatment with international normalized ratio <2. These results strongly suggest that suboptimal anticoagulation management can trigger CAPS in patients with thrombotic APS.

Sections du résumé

BACKGROUND
The prevention of catastrophic antiphospholipid syndrome (CAPS), a rare complication of antiphospholipid syndrome (APS), is a major goal.
OBJECTIVES
We analyzed its precipitating factors, focusing on anticoagulation immediately before CAPS episodes.
METHODS
We retrospectively analyzed patients in the French multicenter APS/systemic lupus erythematosus database with at least 1 CAPS episode. Then we compared each patient with known APS before CAPS with 2 patients with non-CAPS APS matched for age, sex, center, and APS phenotype.
RESULTS
We included 112 patients with CAPS (70% women; mean age, 43 ± 15 years). At least 1 standard precipitating factor of CAPS was observed for 67 patients (64%), which were mainly infections (n = 28, 27%), pregnancy (n = 23, 22%), and surgery (n = 16, 15%). Before the CAPS episode, 67 (60%) patients already had a diagnosis of APS. Of the 61 treated with anticoagulants, 32 (48%) received vitamin K antagonists (VKAs), 23 (34%) heparin, and 2 (3%) a direct oral anticoagulant. They were less likely than their matched patients with APS without CAPS to receive VKA (48% vs 66%, p = .001). Among those treated with VKA, 72% had a subtherapeutic international normalized ratio (ie, <2) versus 28% in patients with APS without CAPS (p < .001). Finally, excluding pregnant patients (n = 14) for whom we could not differentiate the effect of treatment from that of pregnancy, we were left with 47 cases, 32 (68%) of whom had recently begun a direct oral anticoagulant, planned bridging therapy, or had VKA treatment with international normalized ratio <2.
CONCLUSION
These results strongly suggest that suboptimal anticoagulation management can trigger CAPS in patients with thrombotic APS.

Identifiants

DOI: 10.1016/j.jtha.2023.02.007 PMID: 36792010
pubmed: 36792010
pii: S1538-7836(23)00146-0
doi: 10.1016/j.jtha.2023.02.007
pii:
doi:

Substances chimiques

Anticoagulants 0

Types de publication

Multicenter Study Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

1258-1265

Informations de copyright

Copyright © 2023 International Society on Thrombosis and Haemostasis. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of competing interests There are no competing interests to disclose.

Auteurs

Romain Stammler (R)

Internal Medicine Department, AP-HP, Referral Center for Rare Autoimmune and Systemic Diseases of Ile de France, Cochin Hospital, Paris, France.

Yann Nguyen (Y)

Internal Medicine Department, AP-HP, Referral Center for Rare Autoimmune and Systemic Diseases of Ile de France, Cochin Hospital, Paris, France.

Cécile Yelnik (C)

Univ. Lille, Inserm, CHU Lille, Service de Médecine Interne et d'Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du nord et Nord-Ouest de France (CeRAINO), U1167 RID-AGE, F-59000 Lille, France.

Véronique Le Guern (V)

Internal Medicine Department, AP-HP, Referral Center for Rare Autoimmune and Systemic Diseases of Ile de France, Cochin Hospital, Paris, France.

Marc Lambert (M)

Univ. Lille, Inserm, CHU Lille, Service de Médecine Interne et d'Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du nord et Nord-Ouest de France (CeRAINO), U1167 RID-AGE, F-59000 Lille, France.

Romain Paule (R)

Internal Medicine Department, AP-HP, Referral Center for Rare Autoimmune and Systemic Diseases of Ile de France, Cochin Hospital, Paris, France.

Eric Hachulla (E)

Univ. Lille, Inserm, CHU Lille, Service de Médecine Interne et d'Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du nord et Nord-Ouest de France (CeRAINO), U1167 RID-AGE, F-59000 Lille, France.

Luc Mouthon (L)

Internal Medicine Department, AP-HP, Referral Center for Rare Autoimmune and Systemic Diseases of Ile de France, Cochin Hospital, Paris, France.

Anastasia Dupré (A)

Internal Medicine Department, AP-HP, Referral Center for Rare Autoimmune and Systemic Diseases of Ile de France, Cochin Hospital, Paris, France.

Félix Ackermann (F)

Department of Internal Medicine and Clinical Immunology, Foch Hospital, Referral Center for Hypereosinophilic Syndromes, Suresnes, France.

Virginie Dufrost (V)

Vascular Medicine Division and Regional Competence Centre for Rare Vascular and Systemic Autoimmune Diseases, CHRU Nancy, France.

Denis Wahl (D)

Vascular Medicine Division and Regional Competence Centre for Rare Vascular and Systemic Autoimmune Diseases, CHRU Nancy, France.

Bertrand Godeau (B)

Department of Internal Medicine and Clinical Immunology, Mondor Hospital, Paris France.

Gaëlle Leroux (G)

Department of Internal Medicine and Clinical Immunology, AP-HP, La Pitié-Salpêtrière Hospital, Referral Center for Rare Autoimmune and Systemic Diseases, Paris, France; and Sorbonne University.

Ygal Benhamou (Y)

Department of Internal Medicine and Clinical Immunology, Centre Hospitalier de Rouen, Rouen, France.

Estibaliz Lazaro (E)

Department of Internal Medicine and Clinical Immunology, Centre Hospitalier de Bordeaux, Bordeaux, France.

Eric Daugas (E)

Department of Nephrology, AP-HP, Bichat Hospital, Paris, France.

Holy Bezanahary (H)

Department of Internal Medicine and Clinical Immunology, Centre Hospitalier Universitaire de Limoges, Limoges, France.

Arsène Mekinian (A)

Department of Internal Medicine and Clinical Immunology, APHP, Saint Antoine Hospital, Paris, France.

Jean-Charles Piette (JC)

Department of Internal Medicine and Clinical Immunology, AP-HP, La Pitié-Salpêtrière Hospital, Referral Center for Rare Autoimmune and Systemic Diseases, Paris, France; and Sorbonne University.

Nathalie Morel (N)

Internal Medicine Department, AP-HP, Referral Center for Rare Autoimmune and Systemic Diseases of Ile de France, Cochin Hospital, Paris, France.

Nathalie Costedoat-Chalumeau (N)

Internal Medicine Department, AP-HP, Referral Center for Rare Autoimmune and Systemic Diseases of Ile de France, Cochin Hospital, Paris, France; Université Paris Cité, Center for Epidemiology and Statistics, Institut national de la santé et de la recherche médicale, French National Institute for Agricultural Research, Paris, France. Electronic address: nathalie.costedoat@aphp.fr.

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Classifications MeSH

questionsmedicales.fr › Phénomènes physiologiques des appareils urinaire et reproducteur › Phénomènes physiologiques de la reproduction › Reproduction › Grossesse › Precipitating factors of catastrophic...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Precipitating factors of catastrophic...
questionsmedicales.fr › Maladies du système immunitaire › Maladies auto-immunes › Syndrome des anticorps antiphospholipides › Precipitating factors of catastrophic...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents hématologiques › Anticoagulants › Precipitating factors of catastrophic...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Facteurs épidémiologiques › Causalité › Facteurs précipitants › Precipitating factors of catastrophic...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Precipitating factors of catastrophic...
questionsmedicales.fr › Maladies du système immunitaire › Maladies auto-immunes › Lupus érythémateux disséminé › Precipitating factors of catastrophic...