Clinical significance of acquired activated protein C resistance in patients with systemic lupus erythematosus

Abstract

Antiphospholipid antibodies (aPL) may induce acquired activated protein C resistance (acquired APCR). The role of acquired APCR in patients with systemic lupus erythematosus (SLE) is not well known. To evaluate the prevalence of acquired APCR and its association with clinical manifestations we studied 103 consecutive SLE patients and 103 matched controls. APCR in the undiluted test and after dilution in factor V deficient plasma, factor V Leiden, protein C and S, lupus anticoagulant, and anti-cardiolipin, anti-beta2-glycoprotein I and anti-prothrombin antibodies were determined. Factor V Leiden was found in 4% in both patients and controls. The prevalence of acquired APCR was 22% for the undiluted assay and 17% in the diluted test. In SLE patients, acquired APCR was associated with aPL (39 vs 13% in undiluted assay, P = 0.007; and 33 vs 7% in the diluted test, P = 0.001). Arterial thromboses were found in 24% of patients with acquired APCR and in 6% of patients without (P = 0.04). However, no relationship was found with venous thrombosis. Acquired APCR was also associated with pregnancy losses: miscarriages in 70% of women with acquired APCR vs 32% in those without (P=0.03). Thus, in SLE patients acquired APCR seems to be associated with increased prevalence of arterial thrombosis and pregnancy losses.

The contribution of inherited and acquired thrombophilic defects, alone or combined with antiphospholipid antibodies, to venous and arterial thromboembolism in patients with systemic lupus erythematosus

“…In 2 previous studies, APC resistance was associated with VTE in children and with ATE in adults, respectively. 23,24 This discrepancy might be due to differences in the applied laboratory tests.…”

Thrombin generation in antiphospholipid syndrome

“…One study also suggested that acquired APC resistance could also be associated with pregnancy losses. 8 In conclusion, using a thrombin generation based APC sensitivity assay we have shown that patients with SLE and primary APS displayed a hypercoagulable state characterized by APC resistance. Thrombin generation in antiphospholipid syndrome S Zuily et al…”

Is There an Overlap between Sudden Neurosensorial Hearing Loss and Cardiovascular Risk Factors?

“…This gene poly- morphism shows a prevalence of 3-6% in Caucasians and in the population of the Indian subcontinent [Muñoz-Rodríguez et al, 2002]. It has been associated with deep venous thrombosis of legs in young female smokers [Capaccio et al, 2007;Görur et al, 2005;Muñoz-Rodríguez et al, 2002;Rosendaal et al, 1998].…”

“…To detect factor V polymorphism, polymerase chain reaction (PCR) amplification and allele-specific oligonucleotide (ASO) hybridization was performed (mDx Factor V Leiden; BioRad, Hercules, Calif., USA) [Thein and Walance, 1986]. The region of the factor V DNA carrying the Leiden mutation (1691 G ] A) was amplified with 2 specific 5 -biotinilated oligonucleotide primers [Muñoz-Rodríguez et al, 2002]. To detect amplified DNA, ASO probes for the wild or the mutant allele of the factor V gene were used.…”