RESEARCH - Determinants of risk for venous and arterial thrombosis in primary antiphospholipid syndrome and APS with SLE

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J Rheumatol. 2009 May 15.

Determinants of Risk for Venous and Arterial Thrombosis in Primary

Antiphospholipid Syndrome and in Antiphospholipid Syndrome with

Systemic Lupus Erythematosus.

Danowski A, Leitão de Azevedo MN, de Souza Papi JA, Petri M.

From the Rheumatology Department, s Hopkins University School of

Medicine, Baltimore, land, USA; and Rheumatology Department,

Federal University of Rio de Janeiro (HUCFF-UFRJ), Rio de Janeiro,

Brazil.

OBJECTIVE: Antiphospholipid syndrome (APS) is characterized by

thrombosis (venous and arterial) and pregnancy loss in conjunction

with the lupus anticoagulant, IgG or IgM anticardiolipin, or IgG or

IgM anti-ss2-glycoprotein I. In most series, only a minority of

patients with antiphospholipid antibodies develop a clinical

manifestation.

METHODS: A cross-sectional study of consecutive patients in the

Hopkins Lupus Center was performed. Interviews were done and records

were reviewed for the following variables: gender, ethnicity,

hypertension, triglycerides, cholesterol, smoking, diabetes mellitus,

homocysteine, cancer, hepatitis C, hormone replacement therapy/oral

contraceptives, hereditary thrombophilia, anticardiolipin antibodies

IgG, IgM and IgA, and lupus anticoagulant (LAC). Our aim was to

identify risk factors associated with thrombosis and pregnancy loss in

patients with antiphospholipid antibodies.

RESULTS: A total of 122 patients (84% female, 74% Caucasian) were

studied. Patients were divided into 3 groups: primary APS, APS

associated with systemic lupus erythematosus, and patients with

systemic lupus erythematosus (SLE) with antiphospholipid antibodies

but no thrombosis or pregnancy loss. Venous thrombosis was associated

with high triglycerides (p = 0.001), hereditary thrombophilia (p =

0.02), anticardiolipin antibodies IgG > 40 (p = 0.04), and LAC (p =

0.012). Hypertriglyceridemia was associated with a 6.4-fold increase,

hereditary thrombophilia with a 7.3- fold increase, and

anticardiolipin IgG > 40 GPL with a 2.8-fold increase in the risk of

venous thrombosis. Arterial thrombosis was associated with

hypertension (p = 0.008) and elevated homocysteine (p = 0.044).

Hypertension was associated with a 2.4-fold increase in the risk of

arterial thrombosis. No correlations were found for pregnancy loss.

CONCLUSION: The frequency of thrombosis and pregnancy loss is greater

in APS associated with SLE than in primary APS. Risk factors differ

for venous and arterial thrombosis in APS. Treatment of hypertension

may be the most important intervention to reduce arterial thrombosis.

Elevated triglycerides are a major associate of venous thrombosis, but

the benefit of treatment is not known. Hereditary thrombophilia is an

associate of venous but not arterial thrombosis, making it

cost-effective to investigate only in venous thrombosis.

PMID: 19447935

http://www.ncbi.nlm.nih.gov/pubmed/19447935

Not an MD