ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 801

Venothromboembolism in Large Vessel Vasculitis

Sankalp V. Bhavsar1, Nader A. Khalidi2, Simon Carette3, David Cuthbertson4, Peter C. Grayson5, Gary S. Hoffman6, Curry L. Koening7, Carol A. Langford8, Carol McAlear9, Larry Moreland10, Paul A. Monach11, Christian Pagnoux3, Philip Seo12, Kenneth J. Warrington13, Steven R. Ytterberg13 and Peter A. Merkel14, 1Division of Rheumatology, McMaster University, Hamilton, ON, Canada, 2Division of Rheumatology, St. Joseph’s Hospital, McMaster University, Hamilton, ON, Canada, 3Division of Rheumatology, University of Toronto, Toronto, ON, Canada, 4Department of Biostatistics, University of South Florida, Tampa, FL, 5NIAMS Systemic Autoimmunity Branch, National Institutes of Health, Bethesda, MD, 6Center for Vasculitis Care and Research, Cleveland Clinic Foundation, Cleveland, OH, 7Division of Rheumatology, University of Utah, Salt Lake City, UT, 8Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, OH, 9Division of Rheumatology, Vasculitis Center, University of Pennsylvania, Philadelphia, PA, 10Vasculitis Center, of University of Pittsburgh Medical Center, Pittsburgh, PA, 11Section of Rheumatology, Vasculitis Center, Boston University School of Medicine, Boston, MA, 12Rheumatology Division, Johns Hopkins Vasculitis Center, Johns Hopkins University, Baltimore, MD, 13Division of Rheumatology, Mayo Clinic, Rochester, MN, 14University of Pennsylvania, Philadelphia, PA

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: , , ,

Session Information

Title: Vasculitis

Session Type: Abstract Submissions (ACR)

Background/Purpose: Venous thromboembolic disease (VTE) is a recognized characteristic of various systemic vasculitides, particularly small-vessel vasculitis.  However, there are no reports describing the frequency of VTE in Takayasu’s arteritis (TAK) and no large studies examining VTE in patients with giant cell arteritis (GCA) using a standard case definition.  The aim of this study was to determine the prevalence and incidence of VTEs in patients with large-vessel vasculitis (LVV), describe these VTEs, and assess the timing of VTEs in relation to the diagnosis of LVV.

Methods: The data source was the Vasculitis Clinical Research Consortium Longitudinal Studies of TAK and GCA, which enrolled patients with new onset or established disease.  At baseline visits any history of VTE is recorded to determine the baseline prevalence of VTE.  Also collected are data on traditional VTE risk factors such as history of malignancy, hematological disease, and other autoimmune diseases, and use of oral contraceptives or hormone replacement therapy.  In follow-up visits, the occurrence of any new/interval VTEs is recorded.  The timing of new VTEs in relation to the diagnosis of LVV or to flares of LVV was also evaluated. 

Results:   159 patients with TAK and 256 patients with GCA were included for analysis.  In patients with TAK, 5 patients (3.1%) had a history of VTE recorded at the baseline visit.  No patients had identifiable traditional risk factors for VTE.  4 of the 5 events occurred within 4 years of diagnosis.  New VTEs occurred in 4 patients with TAK over a mean observation period of 2.6 years after the baseline visit (incidence 1.0 per 100 person-years vs. a rate of 0.06 per 100 person-years in age matched controls).  No patients experienced a flare of vasculitis when a new VTE was recorded.  One patient with TAK with a new VTE had a history of inflammatory bowel disease.  The overall prevalence of VTE in patients with TAK was 5.7%.  In the GCA group, a history of VTE was recorded at the baseline visit in 12 patients (4.7%).  One patient had a history of estrogen use; no other patients with VTE had a history of identifiable traditional risk factors for VTE.  Over a mean observation period of 3.2 years after the baseline visit, no patients with GCA experienced a new VTE (incidence 0.0/100 person-years).  All 21 VTEs in the patients with LVV occurred in females (p < 0.05).  19% of VTEs occurred within one year of diagnosis of LVV.

Conclusion: This is the first large study to describe VTEs in patients with TAK and GCA using a standardized case definition.  Patients with TAK but not GCA appear to have an increased risk of developing VTEs after diagnosis, especially among female patients.  VTEs in LVV appear likely to occur more frequently around the time of the diagnosis of LVV.  In LVV the pathogenesis of VTE, the role of prophylactic antiplatelet/anticoagulation therapy, and determining if VTEs should be considered a criterion for disease relapse are all areas for future study suggested by these results.

Disclosure:

S. V. Bhavsar,
None;

N. A. Khalidi,
None;

S. Carette,
None;

D. Cuthbertson,
None;

P. C. Grayson,
None;

G. S. Hoffman,
None;

C. L. Koening,
None;

C. A. Langford,
None;

C. McAlear,
None;

L. Moreland,
None;

P. A. Monach,
None;

C. Pagnoux,
None;

P. Seo,
None;

K. J. Warrington,
None;

S. R. Ytterberg,
None;

P. A. Merkel,

Genentech and Biogen IDEC Inc.,

2,

Bristol-Myers Squibb,

2,

GlaxoSmithKline,

2,

Actelion Pharmaceuticals US,

2,

Actelion Pharmaceuticals US,

5,

Sanofi-Aventis Pharmaceutical,

5,

Chemocentryx,

5.

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