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Analysis of risk factors for the development of thrombotic complications in antiphospholipid antibody positive lupus patients

G Lakos

Department of Clinical Immunology, Medical and Health Science Centre, University of Debrecen, Debrcen, Hungary

H P Bhattoa

Department of Clinical Biochemistry and Molecular Pathology, Medical and Health Science Centre, University of Debrecen, Debrcen, Hungary

Y Shoenfeld

Department of Medicine B and Center for Autoimmune Diseases, Sheba Medical Center, Tel-Aviv University, Tel-Aviv, Israel

G Szegedi

Autoimmune Research Group of the Hungarian Academy of Sciences and University of Debrecen, Debrecen, Hungary

E Kiss

Department of Clinical Immunology, Medical and Health Science Centre, University of Debrecen, Debrcen, Hungary; Department of clinical Immunology, Moricz Zs. krt. 22, Debrecen, H-4032, Hungary kiss{at}iiibel.dote.hudrkissemese{at}freemail.hu

The objective of this study was to characterize risk factors for thrombotic events in lupus patients. A total of 272 lupus patients were followed up for five years during which the presence of aPL antibodies [anticardiolipin (aCL), anti-beta2-glycoprotein I (aß2GPI) and lupus anticoagulant (LAC)] were determined, and all thrombotic incidents and antithrombotic therapy-related data were collected. At baseline, three groups were constituted, an aPL–group with 107 aPL negative patients, an aPL+ group with 81 aPL positive patients without clinical thrombosis and a secondary antiphospholipid syndrome (APS) group with 84 aPL+ patients who met the Sapporo criteria. LAC was more common in the APS than the aPL+ group (32.1% versus 9.9%, P < 0.001). The prevalence of clinical thrombotic events was significantly higher when all three types of aPL were present compared to only aCL positive cases. During follow up, aPL appeared in 7.5% of the aPL - group, and 2.8% of this group had thrombotic complications. In the aPL + group, thrombotic events reoccurred in 1.9% of those receiving antithrombotic prophylaxis and 6.9% of those without primary prophylaxis. Despite anticoagulant therapy, thrombotic events reoccurred in 8.3% of the APS group. These findings indicate that LAC, constant and cumulative presence of aPL and previous thrombosis are positive predictors for the development of thrombotic complication in lupus patients.

Key Words: SLE • antiphospholipid antibodies • antiphospholipid syndrome • primary prophylaxis • thrombosis

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