{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T04:57:21Z","timestamp":1781326641287,"version":"3.54.1"},"reference-count":45,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Brazilian Ministry of Science, Technology, and Innovation","award":["308452\/2021-6"],"award-info":[{"award-number":["308452\/2021-6"]}]},{"DOI":"10.13039\/501100001807","name":"S\u00e3o Paulo Research Foundation","doi-asserted-by":"crossref","award":["2022\/13216-0"],"award-info":[{"award-number":["2022\/13216-0"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"crossref"}]},{"name":"FAEPEX-UNICAMP","award":["2023\/04157-3"],"award-info":[{"award-number":["2023\/04157-3"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: To determine whether obstetric antiphospholipid syndrome (oAPS) among women with primary thrombotic APS (tAPS) defines a distinct immunologic phenotype or influences thrombotic characteristics and recurrence risk. Methods: This predefined subgroup analysis was conducted within a multicenter retrospective cohort study of 663 patients with persistent antiphospholipid antibody (aPL) positivity and objectively confirmed thrombosis. The present analysis included 295 women with primary tAPS and a history of pregnancy. Participants were classified as oAPS or non-oAPS according to the revised Sydney criteria. Demographic, clinical, obstetric, immunologic, and hematologic features at baseline were compared. Univariable and multivariable logistic regression analyses were performed to identify predictors of oAPS and determinants of arterial versus venous thrombosis. Results: Of 295 women, 115 (39.0%) met oAPS criteria. ANA positivity (33.0% vs. 19.0%, p = 0.008), triple aPL positivity (46.0% vs. 29.1%, p = 0.003), and severe thrombocytopenia (22.8% vs. 13.3%, p = 0.035) were more frequent in oAPS. In multivariable analysis, ANA positivity remained independently associated with oAPS (adjusted OR 1.94, 95% CI 1.05\u20133.56; p = 0.033), whereas triple aPL positivity and thrombocytopenia did not remain independently significant after adjustment. Thrombotic phenotype and recurrence rates were similar between oAPS and non-oAPS groups. Obstetric history was not associated with arterial events; hypertension was the strongest predictor of arterial thrombosis (adjusted OR 2.61, p &lt; 0.001). Conclusions: In primary tAPS, oAPS is associated with features suggestive of an immune-enriched phenotype, particularly ANA positivity, without evidence of a distinct thrombotic phenotype or increased recurrence risk. Integration of obstetric and immunologic features may help guide risk stratification and hypothesis generation for future studies.<\/jats:p>","DOI":"10.3390\/diagnostics16121794","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:48:35Z","timestamp":1781138915000},"page":"1794","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Combined Obstetric and Thrombotic Complications Are Associated with Features Suggestive of an Immune-Enriched Phenotype Among Women with Thrombotic Antiphospholipid Syndrome (APS)"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0075-5895","authenticated-orcid":false,"given":"Paula","family":"David","sequence":"first","affiliation":[{"name":"Rheumatology Unit, Sheba Medical Center-Tel Hashomer, Ramat Gan 5262100, Israel"},{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS1 3EX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabrielle M.","family":"Santos","sequence":"additional","affiliation":[{"name":"Discipline of Hematology, Hemotherapy and Cell Therapy, Department of Internal Medicine, University of S\u00e3o Paulo Medical School, S\u00e3o Paulo 05403-000, Brazil"},{"name":"State Institute of Hematology Arthur de Siqueira Cavalcanti (HEMORIO), Rio de Janeiro 20211-030, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Or","family":"Hen","sequence":"additional","affiliation":[{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS1 3EX, UK"},{"name":"Internal Medicine C, Sheba Medical Center-Tel Hashomer, Ramat Gan 5262100, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0693-7007","authenticated-orcid":false,"given":"Juan Luis","family":"Ontiveros-Austria","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology, Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n Salvador Zubir\u00e1n, Mexico City 14080, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rotem","family":"Liran","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine E, Meir Medical Center, Kfar Saba 4428164, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8355-433X","authenticated-orcid":false,"given":"Sergio","family":"Rodriguez-Rodriguez","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology, Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n Salvador Zubir\u00e1n, Mexico City 14080, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0412-1729","authenticated-orcid":false,"given":"Yonatan Shneor","family":"Patt","sequence":"additional","affiliation":[{"name":"Internal Medicine B, Sheba Medical Center-Tel Hashomer, Ramat Gan 5262100, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica","family":"Okazaki","sequence":"additional","affiliation":[{"name":"Discipline of Hematology, Hemotherapy and Cell Therapy, Department of Internal Medicine, University of S\u00e3o Paulo Medical School, S\u00e3o Paulo 05403-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5942-1083","authenticated-orcid":false,"given":"Marina","family":"Colella","sequence":"additional","affiliation":[{"name":"Hematology and Hemotherapy Center, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-887, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriela G.","family":"Yamaguti-Hayakawa","sequence":"additional","affiliation":[{"name":"Hematology and Hemotherapy Center, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-887, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9576-7053","authenticated-orcid":false,"given":"Shada","family":"Azem","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Sheba Medical Center-Tel Hashomer, Ramat Gan 5262100, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoav","family":"Elizur","sequence":"additional","affiliation":[{"name":"Internal Medicine B, Sheba Medical Center-Tel Hashomer, Ramat Gan 5262100, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joyce","family":"Annichino-Bizzacchi","sequence":"additional","affiliation":[{"name":"Hematology and Hemotherapy Center, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-887, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erich V. De","family":"Paula","sequence":"additional","affiliation":[{"name":"Hematology and Hemotherapy Center, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-887, Brazil"},{"name":"School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-887, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaked","family":"Beladev","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine E, Meir Medical Center, Kfar Saba 4428164, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6068-0675","authenticated-orcid":false,"given":"Ophira","family":"Salomon","sequence":"additional","affiliation":[{"name":"Thrombosis Unit, Sheba Medical Center-Tel Hashomer, Ramat Gan 5262100, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Demichelis-Gomez","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology, Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n Salvador Zubir\u00e1n, Mexico City 14080, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Barrera-Vargas","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n Salvador Zubir\u00e1n, Mexico City 14080, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5406-7716","authenticated-orcid":false,"given":"Howard","family":"Amital","sequence":"additional","affiliation":[{"name":"Internal Medicine B, Sheba Medical Center-Tel Hashomer, Ramat Gan 5262100, Israel"},{"name":"Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center-Tel Hashomer, Ramat Gan 5262100, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yehuda","family":"Shoenfeld","sequence":"additional","affiliation":[{"name":"Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center-Tel Hashomer, Ramat Gan 5262100, Israel"},{"name":"Dina Recanati School of Medicine, Reichman University, Herzliya 4610101, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Villa\u00e7a","sequence":"additional","affiliation":[{"name":"Discipline of Hematology, Hemotherapy and Cell Therapy, Department of Internal Medicine, University of S\u00e3o Paulo Medical School, S\u00e3o Paulo 05403-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernanda A.","family":"Orsi","sequence":"additional","affiliation":[{"name":"Hematology and Hemotherapy Center, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-887, Brazil"},{"name":"School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-887, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omer","family":"Gendelman","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Sheba Medical Center-Tel Hashomer, Ramat Gan 5262100, Israel"},{"name":"Internal Medicine B, Sheba Medical Center-Tel Hashomer, Ramat Gan 5262100, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1186\/s13075-021-02515-w","article-title":"Clinical characteristics and prognosis of patients with isolated thrombotic vs. obstetric antiphospholipid syndrome: A prospective cohort study","volume":"23","author":"Jiang","year":"2021","journal-title":"Arthritis Res. 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