OC 06.3 - Combined oral contraceptive-associated venous thromboembolism revealing an antiphospholipid syndrome: an international retrospective study of outcomes.

Saturday, July 9, 2022

1:30 PM – 1:45 PM

Location: ICC Capital Suite Room 10&11

Presentation Format: In-Person

Presenting Author(s)

Jean-Christophe R. Gris, MD, PhD

Professor
Department of Hematology, CHU Nîmes, Univ Montpellier, Nîmes, France
Nimes, Languedoc-Roussillon, France

Co-Author(s)

CB

Chloé Bourguignon

Consulting Physician
Department of Haematology, University Hospital, Nîmes
Nîmes, Languedoc-Roussillon, France
SB

Sylvie Bouvier

Physician, Laboratory Medicine
Department of Haematology, University Hospital, Nîmes
NÎmes, Languedoc-Roussillon, France
EN

Eva Nouvellon

Physician, Laboratory Medicine
Department of Haematology, Uinversity Hospital
Nimes, Languedoc-Roussillon, France
JL

Jeremy Laurent

Consulting Physician
Department of Vascular Medicine, University Hospital
Nîmes, Languedoc-Roussillon, France
AP

Antonia Perez-Martin

Head, Professor
Department of Vascular Medicine, University Hospital
Nîmes, Languedoc-Roussillon, France
EM

Eve Mousty

Consulting Physician
Department of Gynaecology and Obstetrics, University Hospital
Nîmes, Languedoc-Roussillon, France
Mariya G. Nikolaeva, MD

professor
Department of Obstetrics and Gynaecology, Altai State Medical University, Barnaul, Russian Federation
Barnaul, Altaisky krai, Russia
JK

Jamilya Khizroeva

Professor of Obstetrics, gynecology and perinatal medicine Department
I.M.Sechenov First Moscow State Medical University
Moscow, Moskva, Russia
VB

Victoria Bitsadze

Professor of Obstetrics, gynecology and perinatal medicine Department
I.M.Sechenov First Moscow State Medical University
Moscow, Moskva, Russia
AM

Alexander Makatsariya

Head of Obstetrics, gynecology and perinatal medicine Department
I.M.Sechenov First Moscow State Medical University
Moscow, Moskva, Russia

Background: Significant limitations in the data used to define the optimal thromboprophylaxis in patients with antiphospholipid antibodies (aPLAbs) and thrombosis include uncertainties in patients with an initial provoked venous thromboembolic event (VTE).

Aims: To describe thrombotic outcomes in women with a first combined oral contraceptives (COC)-associated first VTE and positive aPLAbs, and a low risk of recurrence.

Methods: International multicentric retrospective study on patients referred for thrombophilia screening after a first COC-associated VTE between January 1st 2010 and January 1st 2021, with low risk by HERDOO2 score, taking a low-dose aspirin-mediated secondary thromboprophylaxis, followed each year until 2021. Primary outcome: thrombosis recurrence rate. Secondary outcomes: recurrence rates by the initial VTE subtype (distal deep vein thrombosis DVT, proximal DVT, pulmonary embolism PE); major bleedings.

Results: Data from 264 patients (distal DVT: 62.9%, proximal DVT: 20.1%, PE: 17%), cumulating 1,327.7 patient.years of observation, were collected. Twenty-two thrombosis occurred: 16 distal DVTs, 3 proximal DVTs, 1 PE and 2 transient ischaemic attacks, the recurrence rate of thrombosis being 1.66 per 100 patient.years (p.y; 95%CI: 1 – 2.3). The recurrence rate was 1.06, 2.88 and 2.57 per 100 p.y in women with distal DVT, proximal DVT and PE, respectively (p=0.0336). No major bleeding occurred. Risk factors affecting thrombosis-recurrence free survival of patients were the time between first COC intake and VTE (p < 0.0001), initial proximal DVT (p=0.0035), active smoking (p=0.0008), high positivity for anti-b2GP1 IgG (p=0.0181) and for anti-b2GP1 IgM (p=0.0321).

Conclusion(s): In women with thrombotic antiphospholipid syndrome diagnosed after a first COC-induced VTE, with a low HERDOO2 score, under low-dose aspirin secondary prophylaxis, those with distal DVT had a low risk of recurrence. Recurrence risks were higher in others and was modulated by simple cofactors. These observational data may give some clues for categorising the patients in future randomised controlled trials.