Incidence of a first thromboembolic event in carriers of isolated lupus anticoagulant

Pengo, Vittorio; Testa, Sophie; Martinelli, Ida; Ghirarduzzi, Angelo; Legnani, Cristina; Gresele, Paolo; Passamonti, Serena Maria; Bison, Elisa; Denas, Gentian; Jose, Seena Padayattil; Banzato, Alessandra; Ruffatti, Amelia

doi:10.1016/j.thromres.2014.10.013

Cited by 73 publications

(65 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Specifically, we could observe that the presence of antibodies against domain I of β2-GPI and “triple positivity” were more frequent in patients who had a history of thrombosis. These results confirm and validate several previous reports that have implicated these antibodies in the pathogenesis of APS [9, 10, 12, 13, 29, 30], but they also add to the growing body of evidence that shows inconsistent associations between aPL-associated autoantibodies and anamnestic thrombotic risk [3, 16]. Among non-canonical aPL-associated antibodies [11], such as antibodies against protein Z or prothrombin, we only observed a weak association between higher IgM-isotype antibodies against protein Z and a higher risk of anamnestic thrombosis.…”

Section: Discussionsupporting

confidence: 92%

“…Importantly, approximately three out of four thrombotic events occurred while patients were receiving antithrombotic medication with VKA, LMWH, and/or LDA, suggesting that episodes of hypercoagulability in LA-positive patients can induce overt thrombosis despite antithrombotic therapy. The 10-year cumulative TE incidence of 24.3% compares well to the thrombotic risk observed in the WAPS study [31] and the very large Euro-Phospholipid Project registry [6], but was lower than the value in the recently published Piedmont cohort study [32] and higher than that in the recently published study by Pengo et al [30]. Further, the relative frequencies of arterial and venous events as well as the proportion of patients receiving anticoagulation while developing an event were very similar to the results of the Euro-Phospholipid study [6].…”

Section: Discussionsupporting

confidence: 74%

See 1 more Smart Citation

Cardiovascular risk factors are major determinants of thrombotic risk in patients with the lupus anticoagulant

Posch

Gebhart

Rand

et al. 2017

BMC Med

Self Cite

View full text Add to dashboard Cite

BackgroundPatients with the lupus anticoagulant (LA) are at an increased risk of thrombotic events, which in turn increase the risk of death. Understanding the determinants of thrombotic risk in patients with LA may pave the way towards targeted thromboprophylaxis. In the Vienna Lupus Anticoagulant and Thrombosis Study (LATS), we systematically evaluate risk factors for thrombotic events in patients with LA.MethodsWe followed 150 patients (mean age: 41.3 years, female gender: n = 122 (81.3%), history of thrombosis or pregnancy complications: n = 111 (74.0%)), who tested repeatedly positive for LA until development of thrombosis, death, or censoring. The primary endpoint was a composite of arterial or venous thrombotic events (TEs).ResultsDuring a median follow-up of 9.5 years (range: 12 days–13.6 years) and 1076 person-years, 32 TEs occurred (arterial: n = 16, venous: n = 16; cumulative 10-year TE incidence: 24.3%). A prolonged lupus-sensitive activated partial thromboplastin time (aPTT-LA) (adjusted subdistribution hazard ratio (SHR) = 2.31, 95% CI: 1.07–-5.02), diabetes (adjusted SHR = 4.39, 95% CI: 1.42–13.57), and active smoking (adjusted SHR = 2.31, 95% CI: 1.14–5.02) emerged as independent risk factors of both arterial and venous thrombotic risk. A risk model that includes a prolonged lupus-sensitive aPTT, smoking, and diabetes enabled stratification of LA patients into subgroups with a low, intermediate, and high risk of thrombosis (5-year TE risk of 9.7% (n = 77), 30.9% (n = 51), and 56.8% (n = 22).ConclusionsLong-term thrombotic risk in patients with LA is clustered within subjects harboring typical cardiovascular risk factors in addition to a prolonged lupus-sensitive aPTT, whereas patients with none of these risk factors represent a large subgroup with a low risk of thrombosis.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-017-0807-7) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 74%

Cardiovascular risk factors are major determinants of thrombotic risk in patients with the lupus anticoagulant

Posch

Gebhart

Rand

et al. 2017

BMC Med

Self Cite

View full text Add to dashboard Cite

show abstract

“…In very few patients, NMOSD demelination syndrome may be the presenting feature of a bona fide ATID such as SLE (with or without associated APS) or primary APS 28–30. Our patient had a strong serological proof of APS, including LAC positivity which shows best correlation with clinical events 31. However, actual clinical event is a requirement for the diagnosis of APS and qualifying events are either vascular (venous, arterial or small vessel) thromboses or unexplained fetal loss, not autoimmune demyelination at present.…”

Section: Discussionmentioning

confidence: 67%

SLE presenting as demyelinative autoimmune visual loss

Schattner¹,

Voichanski

Uliel

2018

BMJ Case Reports

View full text Add to dashboard Cite

A healthy 38-year-old woman developed sudden unilateral vision loss due to retrobulbar optic neuritis in the wake of varicella-zoster virus infection. She had no further central nervous system (CNS) lesions. Antinuclear antibodies (ANA) and anti-aquaporin 4 antibodies were found, consistent with neuromyelitis optica (NMO). Later, serial MRIs showed dynamic short-segment and long-segment myelitis lesions, ANA titre increased and additional autoantibodies were found including anti-dsDNA, anti-chromatin/nucleosome and antiphospholipid antibodies. In that setting, NMO can be regarded a rare presenting manifestation of systemic lupus erythematosus (SLE). The relevant literature is reviewed and the implications of NMO spectrum disorder demyelinating syndromes as the first manifestation of SLE (with or without antiphospholipid syndrome) (APS) or their later development (in a patient diagnosed with SLE) as part of the spectrum of neuropsychiatric SLE are analysed in view of recent research developments in the field.

show abstract

“…A recent prospective observational study in 151 LA-positive individuals also found LA positivity to be associated with increased mortality, independent of concomitant positivity for anticardiolipin or anti-β2-GPI. 19 In contrast, Pengo et al 20 recently reported that the risk of thromboembolic events was low in a prospective cohort of individuals with an isolated LA, suggesting that the risk associated with an isolated LA is dependent on the population studied.…”

Section: Discussionmentioning

confidence: 92%

Antiphospholipid Antibodies and the Risk of Stroke in Urban and Rural Tanzania

Mast

Molhoek

Ven

et al. 2016

Stroke

View full text Add to dashboard Cite

Background and Purpose-The burden of stroke is high in sub-Saharan Africa, and improved knowledge of risk factors is needed. Antiphospholipid antibodies are a common acquired stroke risk factor in young individuals. Antiphospholipid antibodies may be induced by infectious diseases. Sub-Saharan Africa has a high infectious burden, and we analyzed the contribution of antiphospholipid antibodies to the risk of stroke in an incident population from rural and urban Tanzania. Methods-Stroke cases and age-and sex-matched community-acquired controls from the rural Hai district and urban Dares-Salaam areas of Tanzania were recruited in a wider study of stroke incidence between June 2003 and June 2006. Lupus anticoagulant, anticardiolipin, anti-β2-glycoprotein I, and antiphosphatidylserine/prothrombin antibodies were determined in stored plasma, as well as IgG antibodies against Treponema pallidum. Results-Data from 158 stroke cases and 369 controls were analyzed. Thirty cases (19%) and 4 controls (1%) had a lupus anticoagulant (odds ratio, 20.8; 95% confidence interval, 7.2-60.5). Anticardiolipin IgG was the only other antiphospholipid antibody subtype associated with increased stroke risk (odds ratio, 2.1; 95% confidence interval, 1.0-4.3), but this association disappeared when corrected for IgG antibodies against Treponema pallidum results. The prevalence of anti-β2-glycoprotein I IgG antibodies in the Tanzanian healthy population was high when Dutch cutoff values were applied (67%), whereas presence of anti-β2-glycoprotein I IgM was associated with a reduced stroke risk (odds ratio 0.3; 95% confidence interval, 0.1-1.1). Conclusions-The presence of lupus anticoagulant is a strong, and to date unrecognized, risk factor for stroke in Tanzania, especially in young and middle-aged individuals.

show abstract

Incidence of a first thromboembolic event in carriers of isolated lupus anticoagulant

Cited by 73 publications

References 30 publications

Cardiovascular risk factors are major determinants of thrombotic risk in patients with the lupus anticoagulant

Cardiovascular risk factors are major determinants of thrombotic risk in patients with the lupus anticoagulant

SLE presenting as demyelinative autoimmune visual loss

Antiphospholipid Antibodies and the Risk of Stroke in Urban and Rural Tanzania

Contact Info

Product

Resources

About