Morbidity and mortality in the antiphospholipid syndrome during a 5-year period: A multicentre prospective study of 1000 patients

R. Cervera, M. A. Khamashta, Y. Shoenfeld, M. T. Camps, S. Jacobsen, E. Kiss, M. M. Zeher, A. Tincani, I. Kontopoulou-Griva, M. Galeazzi, F. Bellisai, P. L. Meroni, R. H.W.M. Derksen, P. G. De Groot, E. Gromnica-Ihle, M. Baleva, M. Mosca, S. Bombardieri, F. Houssiau, J. C. GrisI. Quéré, E. Hachulla, C. Vasconcelos, B. Roch, A. Fernández-Nebro, J. C. Piette, G. Espinosa, S. Bucciarelli, C. N. Pisoni, M. L. Bertolaccini, M. C. Boffa, G. R.V. Hughes

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Objectives: To identify the main causes of morbidity and mortality in patients with antiphospholipid syndrome (APS) during a 5-year period and to determine clinical and immunological parameters with prognostic significance. Methods: The clinical and immunological features of a cohort of 1000 patients with APS from 13 European countries who had been followed up from 1999 to 2004 were analysed. Results: 200 (20%) patients developed APS-related manifestations during the 5-year study period. Recurrent thrombotic events appeared in 166 (16.6%) patients and the most common were strokes (2.4% of the total cohort), transient ischaemic attacks (2.3%), deep vein thromboses (2.1%) and pulmonary embolism (2.1%). When the thrombotic events occurred, 90 patients were receiving oral anticoagulants and 49 were using aspirin. 31/420 (7.4%) patients receiving oral anticoagulants presented with haemorrhage. 3/121 (2.5%) women with only obstetric APS manifestations at the start of the study developed a new thrombotic event. A total of 77 women (9.4% of the female patients) had one or more pregnancies and 63 (81.8% of pregnant patients) had one or more live births. The most common fetal complications were early pregnancy loss (17.1% of pregnancies) and premature birth (35% of live births). 53 (5.3% of the total cohort) patients died. The most common causes of death were bacterial infection (21% of deaths), myocardial infarction (19%) and stroke (13%). No clinical or immunological predictor of thrombotic events, pregnancy morbidity or mortality was detected. Conclusion: Patients with APS still develop significant morbidity and mortality despite current treatment (oral anticoagulants or antiaggregants, or both).

Original languageEnglish
Pages (from-to)1428-1432
Number of pages5
JournalAnnals of the rheumatic diseases
Issue number9
Publication statusPublished - Sep 2009


ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology
  • Biochemistry, Genetics and Molecular Biology(all)

Cite this

Cervera, R., Khamashta, M. A., Shoenfeld, Y., Camps, M. T., Jacobsen, S., Kiss, E., Zeher, M. M., Tincani, A., Kontopoulou-Griva, I., Galeazzi, M., Bellisai, F., Meroni, P. L., Derksen, R. H. W. M., De Groot, P. G., Gromnica-Ihle, E., Baleva, M., Mosca, M., Bombardieri, S., Houssiau, F., ... Hughes, G. R. V. (2009). Morbidity and mortality in the antiphospholipid syndrome during a 5-year period: A multicentre prospective study of 1000 patients. Annals of the rheumatic diseases, 68(9), 1428-1432.