Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Venous thrombotic events (VTE) are the most common complications in patients with persistently positive aPL antibodies (aPL+)1 . The pathogenesis of VTE is multifactorial, and not all aPL+ individuals develop thrombosis2. ABO blood type, a determinant of plasma levels of von Willebrand factor (vWF), is an established VTE risk factor in the general population, but not in aPL+ patients. In the general population, non-type O blood type is associated with a higher risk of VTE. The objective of this study was to investigate the association between ABO blood type and VTE in aPL+ patients.
Methods: We included patients >18 years old followed at an urban tertiary care center between 2000 and 2015 with the serologic criteria for aPL positivity by the revised Sapporo Criteria (anticardiolipin IgG or IgM >40 IU, and/or anti-beta-2- glycoprotein1 IgG or IgM >40 IU or positive lupus anticoagulant measured twice at least 12 weeks apart)3 and a type and screen. VTE were verified by radiological criteria and historical records. Data including age, sex, race, body mass index, smoking status (ever smoker), blood type, hypertension, diabetes, and ever use of aspirin or warfarin were ascertained from chart review. Odds ratios of VTE were estimated with logistic regression models for O vs. non-O blood type. Because there was a significant statistical interaction between sex and ABO, the results were stratified by sex. Logistic regression models were adjusted for age, sex, race, DM, HTN, and smoking status.
Results: Of the 226 study patients, 47 (21%) were men. The rates of VTE were 33% overall, 38% among men, and 32% among women. Overall, men were slightly older, more likely to smoke and to receive anticoagulation (Table 1). There was no association between blood type and VTE in the overall sample (Table 2). However, the frequency of non-O blood type was significantly higher in men with VTE than in men without VTE, 72% and 35%, respectively. The odds of VTE were significantly higher among men with non-O blood type compared to men with O blood type, adjusted OR 4.7 (1.2, 18.7), p=0.03. The association between ABO and VTE was not significant among women. There was no association between ABO blood type and arterial thrombosis.
Conclusion: The association between ABO and VTE varies by sex in aPL+ individuals. Non-O blood type is associated with a higher risk of VTE in men, but not in women. The effects of ABO blood types on vWF in aPL+ individuals may be attenuated by genetic and environmental factors that differ by sex. Understanding the relationship between sex, ABO, and aPL may elucidate thrombosis mechanisms of VTE in aPL+ individuals.
|Table 1. Baseline Characteristics of aPL positive Patients by Sex|
|Patient Characteristics||aPL positive women n=179||aPL positive men n=47||p-value|
|Age at aPL measurement, median (IQR), years||43 (29, 53)||47 (38, 63)||0.02|
|Black race, n (%)||57 (36)||16 (36)||0.92|
|Hispanic ethnicity, n (%)||61 (23)||11 (43)||0.22|
|History of diabetes, n (%)||63 (35)||22 (46)||0.15|
|History of hypertension, n (%)||112 (62)||36 (75)||0.08|
|Ever smoked, n (%)||56 (33)||23 (49)||0.04|
|Low Density Lipoprotein> 100 mg/dl, n (%)*||60 (53)||9 (27)||0.01|
|Body Mass Index, median (IQR), kg/m2||28 (23, 34)||28 (25, 36)||0.55|
|Aspirin use||88 (48)||26 (54)||0.48|
|Anticoagulant use||72 (40)||27 (56)||0.04|
|Prednisone use||88 (48)||26 (54)||0.47|
|SLE by ACR/SLICC Criteria||61 (36)||9 (21)||0.06|
|Non-type O blood type||91 (48)||23 (50)||0.80|
|References 1. Cervera R, et al. Arthritis Rheum. 46:1019–1027 2. Erkan D, et al. Rheumatology. 2002;41(8):924-9 3. Miyakis S, et al. J Thromb Haemost. 2006;4(2):295-306|
|Table 2. Rates and Odds Ratios of VTE for Non-O Blood Type|
|VTE||Non-O Blood Type n (%)||Unadjusted OR for VTE for Non-O Blood Type (95% CI)||p-value||OR for VTE Adjusted for Age, Race, DM, HTN (95% CI)||p-value|
|Overall Sample (n=75)||44 (59)||1.6 (0.94, 2.8)||0.08||1.7 (0.9, 3.1)||0.1|
|Men (n=18)||13 (72)||4.9 (1.4, 17.8)||0.01||4.7(1.2, 18.7)||0.03|
|Women (n=57)||31 (54)||1.2 (0.66, 2.3)||0.52||1.2 (0.58, 2.4)||0.65|
To cite this abstract in AMA style:Shusterman M, Golub E, Mowrey W, Broder AR. the Association Between ABO Blood Types and Venous Thromboembolism in Individuals with a Positive Antiphospholipid Antibody Profile Is Varied By Sex [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/the-association-between-abo-blood-types-and-venous-thromboembolism-in-individuals-with-a-positive-antiphospholipid-antibody-profile-is-varied-by-sex/. Accessed September 21, 2019.
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