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Persistent antiphospholipid antibody (aPL) in asymptomatic carriers as a risk factor for future thrombotic events: a nationwide prospective study.
Lupus. 2014 Dec; 23(14):1468-76.L

Abstract

OBJECTIVES

The long-term prognosis of individuals fulfilling the laboratory criteria, but not clinical criteria, of antiphospholipid syndrome (APS) has not been widely investigated. The primary aim of this study was to evaluate the incidence of first thrombotic event (deep venous thrombosis (DVT), pulmonary embolism (PE), myocardial infarction (MI), stroke or transient ischaemic attack (TIA) in a nationwide antiphospholipid antibody (aPL) carrier cohort.

DESIGN

We conducted a prospective nationwide cohort study.

SETTING

The aPL profile of participants was recorded from the laboratory database. Information was collected about thrombotic and pregnancy complications, subsequent medical history, other risk factors for thrombosis, use of prophylactic antithrombotic medication and general health.

PARTICIPANTS

Participants included adult asymptomatic aPL carriers recognized in Finland during 1971-2009.

MAIN OUTCOME MEASURE

The main outcome measure was incidence of first thrombotic event.

RESULTS

A total of 119 (89% female) aPL carriers were followed for mean (SD) of 9.1 (7.5) years (range 3-41 years). Sixty-one per cent of the study participants had autoimmune disease, most often systemic lupus erythematosus (SLE). Thirty-six of 119 (30%) were either double or triple positive, 56% single lupus anticoagulant (LA) positive, and 8% and 5% single anticardiolipin antibodies (aCL) and anti-β2glycoprotein I antibodies (aβ2GPI) positive, respectively. Nine (7.6%) study patients experienced a first thrombotic event (five DVT, one PE, two MI, one TIA) mean (SD) 7.2 (8.3) years (range 1-26 years) after aPL detection (annual incidence rate 0.8%). All individuals who developed thrombotic complications had autoimmune disease. Annual rate of first thrombotic event in carriers of single positivity (0.65%) was equal to the known risk of thrombosis in the healthy Caucasian population, whereas the rate was two times higher in carriers of double or triple positivity (1.27%). Sixteen of 79 (20%) women experienced pregnancy complications.

CONCLUSIONS

Double or triple positivity for aPL is a risk factor for future thrombotic events, especially in individuals with an underlying autoimmune disease, whereas single positivity does not seem to carry an elevated risk of thrombosis.

Authors+Show Affiliations

Department of Internal Medicine, Keski-Suomi Central Hospital, Jyväskylä, Finland.Department of Haemostasis, Finnish Red Cross Blood Transfusion Service, Helsinki, Finland University of Helsinki, Faculty of Medicine, Helsinki, Finland.Department of Haemostasis, Finnish Red Cross Blood Transfusion Service, Helsinki, Finland.Department of Haemostasis, Finnish Red Cross Blood Transfusion Service, Helsinki, Finland marja.puurunen@veripalvelu.fi.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25164304

Citation

Mustonen, P, et al. "Persistent Antiphospholipid Antibody (aPL) in Asymptomatic Carriers as a Risk Factor for Future Thrombotic Events: a Nationwide Prospective Study." Lupus, vol. 23, no. 14, 2014, pp. 1468-76.
Mustonen P, Lehtonen KV, Javela K, et al. Persistent antiphospholipid antibody (aPL) in asymptomatic carriers as a risk factor for future thrombotic events: a nationwide prospective study. Lupus. 2014;23(14):1468-76.
Mustonen, P., Lehtonen, K. V., Javela, K., & Puurunen, M. (2014). Persistent antiphospholipid antibody (aPL) in asymptomatic carriers as a risk factor for future thrombotic events: a nationwide prospective study. Lupus, 23(14), 1468-76. https://doi.org/10.1177/0961203314545410
Mustonen P, et al. Persistent Antiphospholipid Antibody (aPL) in Asymptomatic Carriers as a Risk Factor for Future Thrombotic Events: a Nationwide Prospective Study. Lupus. 2014;23(14):1468-76. PubMed PMID: 25164304.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Persistent antiphospholipid antibody (aPL) in asymptomatic carriers as a risk factor for future thrombotic events: a nationwide prospective study. AU - Mustonen,P, AU - Lehtonen,K V, AU - Javela,K, AU - Puurunen,M, Y1 - 2014/08/27/ PY - 2014/8/29/entrez PY - 2014/8/29/pubmed PY - 2015/7/15/medline KW - Antiphospholipid antibodies KW - anticardiolipin antibodies KW - lupus anticoagulant KW - thrombosis KW - β2-glycoprotein I antibodies SP - 1468 EP - 76 JF - Lupus JO - Lupus VL - 23 IS - 14 N2 - OBJECTIVES: The long-term prognosis of individuals fulfilling the laboratory criteria, but not clinical criteria, of antiphospholipid syndrome (APS) has not been widely investigated. The primary aim of this study was to evaluate the incidence of first thrombotic event (deep venous thrombosis (DVT), pulmonary embolism (PE), myocardial infarction (MI), stroke or transient ischaemic attack (TIA) in a nationwide antiphospholipid antibody (aPL) carrier cohort. DESIGN: We conducted a prospective nationwide cohort study. SETTING: The aPL profile of participants was recorded from the laboratory database. Information was collected about thrombotic and pregnancy complications, subsequent medical history, other risk factors for thrombosis, use of prophylactic antithrombotic medication and general health. PARTICIPANTS: Participants included adult asymptomatic aPL carriers recognized in Finland during 1971-2009. MAIN OUTCOME MEASURE: The main outcome measure was incidence of first thrombotic event. RESULTS: A total of 119 (89% female) aPL carriers were followed for mean (SD) of 9.1 (7.5) years (range 3-41 years). Sixty-one per cent of the study participants had autoimmune disease, most often systemic lupus erythematosus (SLE). Thirty-six of 119 (30%) were either double or triple positive, 56% single lupus anticoagulant (LA) positive, and 8% and 5% single anticardiolipin antibodies (aCL) and anti-β2glycoprotein I antibodies (aβ2GPI) positive, respectively. Nine (7.6%) study patients experienced a first thrombotic event (five DVT, one PE, two MI, one TIA) mean (SD) 7.2 (8.3) years (range 1-26 years) after aPL detection (annual incidence rate 0.8%). All individuals who developed thrombotic complications had autoimmune disease. Annual rate of first thrombotic event in carriers of single positivity (0.65%) was equal to the known risk of thrombosis in the healthy Caucasian population, whereas the rate was two times higher in carriers of double or triple positivity (1.27%). Sixteen of 79 (20%) women experienced pregnancy complications. CONCLUSIONS: Double or triple positivity for aPL is a risk factor for future thrombotic events, especially in individuals with an underlying autoimmune disease, whereas single positivity does not seem to carry an elevated risk of thrombosis. SN - 1477-0962 UR - https://www.unboundmedicine.com/medline/citation/25164304/Persistent_antiphospholipid_antibody__aPL__in_asymptomatic_carriers_as_a_risk_factor_for_future_thrombotic_events:_a_nationwide_prospective_study_ L2 - https://journals.sagepub.com/doi/10.1177/0961203314545410?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -