Fattori di rischio per il primo evento trombotico in soggetti positivi per anticorpi antifosfolipidi. Studio multicentrico, prospettico, di follow-up
Year: 2010
Type: dissertation
Study design: Observational Study
Abstract: RISK FACTORS FOR A FIRST THROMBOTIC EVENT IN ANTIPHOSPHOLIPID ANTIBODY CARRIERS. A MULTICENTRE, PROSPECTIVE, FOLLOW-UP STUDY Background. Antiphospholipid syndrome (APS) is defined by the persistent presence of antiphospholipid antibodies (aPL) in the blood in association with thrombotic events and/or pregnancy morbidity. Several studies have recently endeavoured to identify the predictors of thrombotic events in aPL carriers, but substantial differences in study designs, patient selection criteria, aPL profiles and risk factors make it is difficult to draw any conclusions. Objectives. To asses risk factors for first thrombotic events in aPL positive carriers and to evaluate the efficacy of prophylactic treatments. Methods. The study included patients/subjects attending 11 Rheumatologic Centres belonging to the network of the APS Study Group of the Italian Society of Rheumatology. The inclusion criteria were the following: age between 18 and 65 years and no history of thrombosis. The laboratory criteria were: two consecutive, positive aPL tests carried out, in accordance with the Sydney criteria, at least 12 weeks apart. Women with APS-related pregnancy morbidity were also included. Demographic, laboratory and clinical parameters were collected at enrolment and once a year during the follow-up period. Testing was also carried out at the time of the thrombotic event. Anticardiolipin and anti-beta2 Glycoprotein I antibodies were measured in 5 Centres by “in-house” ELISAs and in the remaining 6 Centres by commercial kits. Lupus Anticoagulant (LA) was tested using platelet-poor plasma following internationally accepted guidelines. Results. Two hundred fifty-eight patients/subjects (223 women and 35 men; mean age: 40.9 years ± 11.1 SD) were recruited between October 2004 and October 2008. The mean follow-up was 35.0 months ± 11.9 SD. Fourteen patients (5.4%, with an annual incidence rate of 1.86%) developed a first thrombotic event (9 venous and 5 arterial) during the follow-up period. Seven of these were receiving prophylactic treatment at the time of the event (6 continuous and 1 during pregnancy prophylaxis). Five of the first-time events occurred during high risk periods (pregnancy/puerperium, immobilization or surgery). Hypertension and LA activity were identified by multivariate logistic regression analysis as independent risk factors for thrombosis (OR=3.6 with 95% CI= 1.2-11, p<0.05 and OR=3.7 with 95% CI= 1-13.8, p<0.05, respectively). It was found, moreover, that thromboprophylaxis with low dose aspirin (100 mg) and/or heparin during high risk periods was significantly protective (OR=0.1 with 95% CI= 0.01-0.9, p<0.05), whereas .prophylaxis continuously administered was not protective Conclusions. The findings of this prospective, follow-up study is in line with those of our previous retrospective one as hypertension was found to be a risk factor for first thrombotic events in asymptomatic aPL carriers. LA was found to be a risk factor for thrombosis, and thromboprophylaxis, administered during high risk periods, was, indeed, protective.
Author: Manuela Ciprian
Language: Italian
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2288074507