RESEARCH - Risk factors for a first thrombotic event in antiphospholipid antibody carriers

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Ann Rheum Dis. Published Online First: 23 September 2008.

doi:10.1136/ard.2008.096669

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Concise Report

Risk factors for a first thrombotic event in antiphospholipid antibody

carriers. A multicenter retrospective follow-up study

A Ruffatti 1*, T Del Ross 1, M Ciprian 1, M Nuzzo 2, M Rampudda 1, M T

Bertero 3, R Bergia 3, P Caramaschi 4, D Biasi 4, F Capsoni 5, L

Montaguti 6, R Ruffini 6, A Brucato 7, U Picillo 8, V Fanelli 9, V

Riccieri 10, A Piccoli 11, G Valesini 10, A Doria 1, PL Meroni 9 and A

Tincani 2

1 Rheumatology Unit, Department of Clinical and Experimental Medicine,

University of Padua, Italy

2 Rheumatology and Clinical Immunology Units, University of Brescia, Italy

3 Mauriziano Hospital, Turin, Italy

4 Rheumatology Unit, Department of Clinical and Experimental Medicine,

University of Verona, Italy

5 Rheumatology Unit, IRCCS Galeazzi, University of Milan, Italy

6 Rheumatology Unit, Bufalini Hospital, Cesena, Italy

7 Department of Internal Medicine, Hospital of Bergamo, Italy

8 Insitute of Clinical Medicine, II University of Naples, Italy

9 Department of Internal Medicine, Auxologico Institute, University of

Milan, Italy

10 Rheumatology Unit, Department of Clinical Medicine and Medical

Therapy, University La Sapienza, Rome, Italy

11 Nephrology Unit, Department of Medical and Surgical Sciences,

University of Padua, Italy

Abstract

Objectives: To asses risk factors for a first thrombotic event in

antiphospholipid antibody (aPL) positive carriers and to evaluate the

efficacy of prophylactic treatments.

Methods: Recruitment criteria were: age 18-65 years, no history of

thrombosis, positivity for lupus anticoagulant and/or IgG and/or IgM

anticardiolipin antibody (aCL) on two or more occasions at least 6

weeks apart. Patients with antiphospholipid syndrome related pregnancy

morbidity were included. Demographic, laboratory and clinical

parameters were collected at enrollment and at the time of the

thrombotic event.

Results: We retrospectively analyzed 370 patients/subjects (344 women

and 26 men; mean age: 34 years ± 9.9 SD, range 18-65) for a mean

follow-up of 59.3 months ± 45.5 SD (range 5-239). Thirty patients

(8.1%, annual incidence rate 1.64%) developed a first thrombotic event

(60% arterial and 40% venous) during the follow-up. Hypertension and

medium/high levels of IgG aCL were identified by multivariate logistic

regression analysis as independent risk factors for thrombosis.

Thromboprophylaxis during high risk and long-term periods was

significantly protective.

Conclusions: Our findings suggest that hypertension and/or medium/high

titres of IgG aCL are risk factors for a first thrombotic event in

asymptomatic aPL carriers and that primary prophylaxis is protective.

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http://ard.bmj.com/cgi/content/abstract/ard.2008.096669v1?papetoc

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