SEARCHCOHORThematology, internal medicine

cohort·hematology, internal medicine, rheumatology, immunology, epidemiology·PMC10879794

Bleeding events in thrombotic antiphospholipid syndrome: prevalence, severity, and associated damage accrual

Research and Practice in Thrombosis and Haemostasis · 4 authors, 5 centres

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TL;DR

This retrospective cohort study found that 40.6% of 197 patients with thrombotic antiphospholipid syndrome experienced a bleeding event during follow-up, with 16% of patients experiencing a major bleed and 7.6% of patients sustaining permanent organ damage not recognized by the current Damage Index for Antiphospholipid Syndrome.

Full summary

725 CHARS

All patients were exposed to antithrombotic therapy. The study characterized 167 bleeding events, classifying them by ISTH definitions. The prevalence of any bleeding was 40.6% (6.9 events per 100 patient-years), with major bleeds accounting for 22.8% of events. Central nervous system involvement was noted in 20.9% of bleeds, and 62.9% of those were major. Bleeding events were spontaneous in 90.4% of cases. Critically, damage defined as permanent organ dysfunction or resection occurred in 11.4% of bleeds, affecting 7.6% of patients, with most damage linked to central nervous system events. Limitations include the retrospective design and challenges in confirming consecutive patient recruitment over a long timeframe.

STUDY TYPE

cohort

SPECIALTY

hematology

SUMMARISED BY

AI pipeline

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100% · A

ORIGINAL PAPER

PMC10879794

Bleeding events in thrombotic antiphospholipid syndrome: prevalence, severity, and associated damage accrual

Research and Practice in Thrombosis and Haemostasis

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ABSTRACT

Abstract Background Life-long anticoagulation increases bleeding risk in patients with antiphospholipid syndrome (APS). The Damage Index for Antiphospholipid Syndrome does not include bleeding events in damage accrual. Objectives We aimed to characterize the prevalence, severity, and damage associated with bleeding events in patients with APS. Methods This was a single-center retrospective analysis of patients with thrombotic APS (2006 Sydney criteria). Bleeding events were reviewed up to 43 years and classified according to the ISTH definitions into 2 groups: 1) major bleedings and 2) nonmajor bleedings (minor bleedings and clinically relevant nonmajor bleedings). Damage events were recorded as bleeding events a) resulting in permanent (>6 months) decrease in organ function and b) complicated by total/partial organ resection. Results Among 197 patients (2412 patient-years [PYs] of follow-up), all of whom had been exposed to antithrombotic therapy, 40.6% experienced 167 bleedings (6.9 events per 100 PYs), of whom 61.3% had nonmajor bleedings (77.2% of bleedings: 42.6% minor, 57.4% clinically relevant nonmajor) and 38.8% had major bleedings (22.8% of bleedings; 1.6 events per 100 PYs). Soft/connective tissue was affected in 44.3% of bleedings, and 94.6% were nonmajor bleedings. Central nervous system was affected in 20.9% of bleedings, and 62.9% were major bleedings. Bleeding events were spontaneous in 90.4% of cases, and thrombocytopenia was likely involved in 62.2% of bleedings. Damage occurred in 11.4% of bleedings and affected 7.6% of patients. Most of the damage was associated with central nervous system events (8.4% of all bleedings). Conclusion Approximately 40% of patients experienced at least 1 bleeding, and almost 8% of patients were left with organ damage not recognized by the current version of the Damage Index for Antiphospholipid Syndrome. Keywords: anticoagulants, antiphospholipid syndrome, antithrombotic agents, bleeding, damage, prevalence

CITATION EXPORT

Pedro Gaspar, Prabal Mittal, Hannah Cohen et al.. Bleeding events in thrombotic antiphospholipid syndrome: prevalence, severity, and associated damage accrual. Research and Practice in Thrombosis and Haemostasis. (2024). https://doi.org/10.1016/j.rpth.2024.102327

AUTHORS

4 · 5 CENTRES

Pedro Gaspar, Prabal Mittal, Hannah Cohen, David A Isenberg

1Department of Internal Medicine, Hospital Santa Maria, Unidade Local de Saúde Santa Maria, Lisbon, Portugal
2Instituto de Medicina Molecular João Lobo Antunes, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
3Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
4Haemostasis Research Unit, Department of Haematology, University College London, London, UK
5Centre for Rheumatology, Division of Medicine, University College London, London, UK