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

BMC Medicine

Research Article

Cihan Ay¹  Silvia Koder¹  Ingrid Pabinger¹  Johanna Gebhart¹  Florian Posch²  Peter Quehenberger³  Jacob H. Rand⁴  Vittorio Pengo⁵ 

[1] Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria;Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria;Division of Oncology, Department of Internal Medicine, Medical University of Graz, Vienna, Austria;Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria;Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA;Division of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy;

关键词: Lupus anticoagulant;    Antiphospholipid antibody syndrome;    Thrombotic risk;    Risk stratification model;    Second hit;    diabetes;    aPTT;    Smoking;    Cardiovascular risk factors;   

DOI  :  10.1186/s12916-017-0807-7

 received in 2016-11-13, accepted in 2017-02-06,  发布年份 2017

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY   
© The Author(s). 2017