Session Information
Date: Sunday, November 5, 2017
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Prevalence of antiphospholipid antibodies in general population has been reported in about 5%. Impact of different thrombophilias in clinical thromboembolic disease is difficult to estimate. Our objective was to assess prevalence (global and in patients < 40 years) of Antiphospholipid Syndrome (APS) in a prospective Institutional Registry of Thromboembolic Disease at a tertiary university hospital
Methods: A prospective cohort study evaluated all consecutive incident cases of pulmonary thromboembolism (PTE) and deep vein thrombosis (DVT) confirmed in patients over the age of 18 between january 1st 2011 and December 31st 2014 at a university hospital. All patients with venous thromboembolic disease (VTED), confirmed by venous doppler ultrasound and/or multislice computed tomographic angiography and/or angioMRI and/or ventilation/perfusión scan and/or angiography, were included in the registry after given informed consent. A personal interview was performed and clinical (risk factors, comorbidities, etc) and laboratory data were collected. Patients were contacted annually after incident event in order to assess clinical status, treatments, adverse events, recurrence or death. Electronic medical records of all patients included in the registry were reviewed. APS prevalence was estimated and patients’ characteristics were compared with other VTED etiologies
Results: 1294 patients with VTED were included in the registry in this period [females 54.9%, mean age 68.8 years (SD 15.7)]. VTED was attributed to APS in 23 patients [females 73.9%, mean age 59.6 (SD 18.2)], representing 1.8% of all patients and 3.8% of patients <= 40 years (Table 1). APS was associated with other autoimmune diseases in 7 patients (30.4%) (4 SLE, 2 RA, 1 overlap). Patients with APS and other thrombophilias were younger than patients with other etiologies (p<0.001) (Table 2). Type of event and event mortality were similar across groups (Table 2). Having a prior/recurrent event was more frequent in patients with APS and other thrombophilias. In a multivariate logistic regression analysis, younger age (OR 1.03, CI 1.01-1.06), female sex (OR 1.64, CI 1.06-1.86) and a prior VTED event (OR 6.3, CI 2.5-16.1), were significantly associated with APS as the cause of the event.
Table 1. Registry patients’ characteristics
|
All patients (n=1294) |
Patients <= 40 years (n=79) |
||
|
Females, n (%) |
713 (54.9) |
46 (58.2) |
|
|
Mean age at diagnosis, years(SD) |
68.8 (15.7) |
30.2 (6.6) |
|
|
Main cause of DVT/PTE, % (CI 95%) |
|
|
|
|
– Cancer |
34.2 (31.6-36.8) |
22.8 (14.8-33.4) |
|
|
– Immobility |
15.6 (13.7- 17.6) |
5.1 (1.9-12.8) |
|
|
– Major surgery |
14.8 (13-16.8) |
20.2 (12.7-30.6) |
|
|
– Thrombophilias (other than APS) |
5.6 (4.5-7) |
12.7 (6.9-22) |
|
|
– Antiphospholipid syndrome |
1.8 (1.2-2.6) |
3.8 (1.2-11.2) |
|
|
– Recent journey |
1.3 (0.8-2.1) |
2.5 (0.6-9.6) |
|
|
– Oral contraceptives/hormonal replacement |
1.2 (0.7-1.9) |
10.1 (5.1-19) |
|
|
– Pregnancy/puerperium |
0.5 (0.2-1) |
6.3 (2.6-14.4) |
|
|
– Thrombocytosis |
0.4 (0.2-0.9) |
0 |
|
|
– Multiple causes |
10.3 (8.7-12) |
7.6 (3.4-16) |
|
|
– Unknown |
14.5 (12.7-16.5) |
8.9 (0.4-17.5) |
|
Table 2. APS patients’ characteristics in comparison with other etiologies
|
APS patients (n=23) |
Other Thrombophilias (n=73) |
Other causes of VTED (n=1201) |
P value
|
|
|
Female, n (%) |
17 (73.9) |
42 (57.5) |
654 (54.5) |
0.2 |
|
Mean age at diagnosis, years (SD) |
59.6 (18.2) |
61.3 (17.6) |
69.4 (15.4) |
<0.001 |
|
Event type, n (%) |
|
|
|
|
|
– DVT |
12 (52.2) |
46 (63.1) |
687 (57.3) |
0.55 |
|
– PTE |
6 (26.1) |
16 (21.9) |
344 (28.7) |
0.44 |
|
– DVT + PTE |
5 (21.7) |
11 (15.1) |
167 (13.9) |
0.55 |
|
Event mortality, n (%) |
0 (0) |
4 (5.5) |
110 (9.2) |
0.18 |
|
On anticoagulation at event time, n (%) |
7 (30.4) |
14 (19.2) |
129 (10.8) |
0.002 |
|
Prior event, n (%) |
11 (47.8) |
24 (32.9) |
140 (11.7) |
<0.001 |
|
Type of prior event, n (%) |
|
|
|
|
|
– DVT |
6 (26.1) |
18 (24.7) |
105 (8.8) |
<0.001 |
|
– PTE |
2 (8.7) |
3 (4.1) |
12 (1) |
0.001 |
|
– DVT + PTE |
3 (13.1) |
3 (4.1) |
23 (1.9) |
0.001 |
|
Follow-up after event , years, median (IQR) |
1.9 (0.1-4.5) |
3.2 (0.8-4.5) |
1.1 (0.1-3.1) |
<0.001 |
|
Recurrence of any thrombotic event during follow up, n (%) |
4 (17.4) |
14 (19.2) |
40 (3.3) |
<0.001 |
|
Comorbidities, n (%) |
|
|
|
|
|
– Hypertension |
15 (65.2) |
36 (49.3) |
780 (65.1) |
0.02 |
|
– Diabetes |
5 (21.7) |
10 (13.7) |
190 (15.9) |
0.6 |
|
– Dyslipidemia |
12 (52.2) |
27 (36.9) |
483 (40.3) |
0.4 |
|
– Active Smoker |
6 (26.1) |
28 (38.4) |
379 (31.6) |
0.4 |
|
– Major cardiovascular event |
5 (21.7) |
6 (8.2) |
144 (12.1) |
0.2 |
|
– Heart failure |
2 (8.7) |
3 (4.1) |
93 (7.8) |
0.5 |
Conclusion: APS- related VTED events represented 1.8% of total events in this registry. Younger age, female sex and having had a prior event were significantly associated with APS
To cite this abstract in AMA style:
Luissi A, Scolnik M, Grande Ratti MF, Posadas Martinez ML, Soriano ER. Burden of Antiphospholipid Syndrome in a Thromboembolic Disease Registry [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/burden-of-antiphospholipid-syndrome-in-a-thromboembolic-disease-registry/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/burden-of-antiphospholipid-syndrome-in-a-thromboembolic-disease-registry/