Background/Purpose: Phosphatidylethanolamine, a zwitterionic phospholipid, is a major component of the cell plasma membrane. Phospatidylethanolamine exerts both anticoagulant and procoagulant activities in different conditions. The prevalence of anti-phosphatidylethanolamine antibodies has been reported to be higher in patients with recurrent pregnancy losses or a history of thrombosis. We studied the association of anti-phosphatidylehtanolamine (anti-PE) with thrombosis and pregnancy loss in SLE, compared with the lupus anticoagulant.
Methods: Stored plasma samples from 268 SLE patients were tested for IgG and IgM antiphosphatidylethanolamine by ELISA. The lupus anticoagulant (LAC) was detected using dRVVT with confirmatory testing.
Results: Anti-PE was found in 9 (6.6%) patients with a history of any thrombosis, 6 (6.8%) with a history of venous thrombosis and in 2 (4.6%) with stroke. Table 1 shows the association of any thrombosis, venous thrombosis, stroke and pregnancy loss with anti-PE and with the lupus anticoagulant. No significant association was found between anti-PE and thrombosis, venous thrombosis, stroke or pregnancy loss. Anti-PE was significantly associated with the lupus anticoagulant. (Table 2)
Table 1: Associations of aPE and Lupus Anticoagulant with Thrombosis and Pregnancy loss
|
|
|
Group with the event |
Group without the event |
Odds Ratio
|
95% CI |
P-value when age, gender, and ethnicity were controlled |
|
|
Assay |
N (% positive) |
N (% positive) |
|
|
|
|
Any Thrombosis |
Anti-PE |
9 (6.6) |
8(6.1) |
1.1 |
0.4,3.1 |
0.85 |
|
LAC |
47 (39.2) |
14 (12.2) |
4.4 |
2.1,8.90 |
<0.0001 |
|
|
Venous Thrombosis |
Anti-PE |
6(6.8) |
11(6.1) |
1.2 |
0.4,3.3 |
0.76 |
|
LAC |
32 (41.6) |
29(18.4) |
3.1 |
1.6,5.90 |
0.0005 |
|
|
Stroke |
Anti-PE |
2 (4.6) |
15(6.7) |
0.7 |
0.1,5.4 |
0.71 |
|
LAC |
16(41.0) |
45(23.0) |
2.5 |
1.20,5.40 |
0.018 |
|
|
Pregnancy Loss |
Anti-PE |
0(0.0) |
4(9.3) |
0.62 |
0.03,15.9 |
0.78 |
|
LAC |
1(16.7) |
7(18.4) |
0.98 |
0.93, 1.0 |
0.34 |
Table 2: Association of Anti-PE with Lupus Anticoagulant
|
|
Lupus anticoagulant Positive ( n = 61) |
Lupus anticoagulant Negative (n = 174) |
Odds Ratio
|
(95% CI) |
P-value |
|
Assay |
N (% positive) |
N (% positive) |
|
|
|
|
Anti-PE(IgG or IgM) |
8 (13.1) |
8 (4.6) |
3.1 |
(1.1, 8.7) |
0.036 |
Conclusion: Anti-PE (IgG or IgM) is associated with the lupus anticoagulant by dRVVT. We found that the lupus anticoagulant by dRVVT was a stronger predictor of any thrombosis, venous thrombosis and stroke than anti-PE. In contrast to other studies, there was no association of anti-PE with thrombosis or pregnancy loss. In SLE, neither the lupus anticoagulant nor anti-PE was associated with a history of pregnancy loss.
Disclosure:
E. Akhter,
None;
H. Fang,
None;
N. Bardin,
None;
M. San Marco,
None;
M. Petri,
None.
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