Thrombosis in systemic lupus erythematosus: Congenital and acquired risk factors

Abstract

Objective. To investigate the thrombotic tendency in patients with systemic lupus erythematosus (SLE) by evaluating congenital or acquired abnormalities associated with an increased risk of venous and/or arterial thrombosis. Methods. A total of 57 patients with SLE were included in the study. Twenty-one patients (37%) had a history of arterial and/or venous thrombosis and 36 patients (63%) did not have such a history. Sera from 50 healthy controls were examined. Protein C, protein S, antithrombin, D-dimer, fibrinogen, homocysteine, anticardiolipin antibodies (aCL), lupus anticoagulant (LAC), prothrombin G20210A, and methylenetetrahydrofolate reductase (MTHFR) C677T gene mutation were evaluated. Results. Protein C, antithrombin, fibrinogen, D-dimer, and homocysteine levels were significantly higher in patients with SLE than in controls. A prothrombin mutation was observed in 2 (4%) of 50 controls and in 6 (11%) of 57 patients. A significantly higher prevalence (P ‫؍‬ 0. 036) of MTHFR homozygous mutation was observed in patients with SLE (14 [25%] of 57) in comparison with controls (4 [8%] of 50). IgG-aCL and IgM-aCL levels were significantly higher in patients with SLE than in controls (P < 0.0001). The presence of medium-high (>20 IgG phospholipid units/ml) IgG-aCL antibody titers was significantly higher (P ‫؍‬ 0.005) in patients with thrombosis (11 [52%] of 21) than in patients without (5 [14%] of 36) thrombosis. LAC was present in 22 (38.5%) of 57 patients and in none of 50 controls. Conclusion. In this study, we confirm the association between thrombosis and IgG-aCL at medium-high titers and suggest that the coexistence of other risk factors can affect the expression of thrombosis in patients with SLE.

Rate and determinants of progression of atherosclerosis in systemic lupus erythematosus

“…Homocysteine concentrations showed a strong tendency to be higher in SLE patients with atherosclerosis in our baseline study of 197 patients (8.6 Ϯ 4.3 versus 7.3 Ϯ 2.6 moles/liter in those without atherosclerosis; P ϭ 0.06) (5). In contrast, Afeltra and colleagues (28), in a study of 57 patients, 21 of whom had venous and/or arterial thromboses, noted elevated levels (Ͼ15 moles/liter) in 14% of them; however, homocysteine concentrations were not significantly higher in patients with thromboses compared with those without them. In the recent study by Von Feldt and colleagues (29), coronary artery calcification, as measured by electron beam computed tomography in patients with SLE, was independently associated with homocysteine concentrations.…”

Serum markers thrombophilia in pregnant women with Systemic Lupus Erythematosus

“…The presence of antiphospholipid antibodies in patients with SLE has been described, 11,13,19 but markers for hereditary thrombophilia are not well characterized, and varying methodologies make it difficult to compare data. [8][9][10] The prevalence of antiphospholipid antibodies in SLE patients is approximately 40%, and between 12% and 44% of patients are positive for anticardiolipin, 15% to 34% are positive for lupus anticoagulant and 10% to 19% are positive for the anti-β 2 -glycoprotein I (β 2 -GPI anti). 13 These data agree with the results of the present study, where 40% (10/25) of patients had markers for antiphospholipid antibodies.…”

“…6,7 In despite of these information, previous reports regarding hereditary thrombophilia serum markers are addressed in nonpregnant women with SLE. [8][9][10] Large numbers of complications can occur in pregnant women with SLE. Possible adverse events include reactivation of the disease, thrombosis and miscarriage in women with antiphospholipid antibodies, neonatal lupus, hypertension and toxicity of drugs used to treat SLE.…”

A Monoclonal Antibody against Human Homocysteine-Induced Endoplasmic Reticulum Protein (Herp): A Useful Tool for Evaluating Endoplasmic Reticulum Stress

“…Homocysteine-induced ER stress contributes to the development of atherosclerosis in apolipoprotein E-deficient mice (Zhou et al 2004) and a high level of plasma homocysteine is one of the risk factors for atherosclerosis (Lawrence et al 2003), ischemic cardiovascular diseases, cerebrovascular diseases, and thrombosis ). An increased level of plasma homocysteine is observed in patients with systemic lupus erythematosus and is an independent risk factor for thromboembolic events or cardiac valvular abnormalities in these patients (Petri et al 1996;Jensen-Urstad et al 2002;Refai et al 2002;Afeltra et al 2005).…”