Session Type: Abstract Submissions (ACR)
Arterial event are frequent in the antiphospholipid syndrome (APS) and stroke is a major clinical manifestation of syndrome. Recently, we conducted a study in a large cohort of Systemic Lupus Erythematosus (SLE) patients applying a risk score for APS clinical manifestations (Global APS Score or GAPSS), demonstrating that risk profile for APS can be successfully assessed. In this study, we aimed to evaluate the clinical usefulness of the GAPSS in differentiating between transient ischemic attack (TIA) and stroke in a cohort of patients tested positive for aPL who sufferedcerebrovascular events.
Methods: We included 40 consecutive SLE patients attending the Louise Coote Lupus Unit at St Thomas Hospital, London, all with a history of cerebravoscular events. Demographic, clinical and laboratory characteristics were collected. aPL profile included anticardiolipin antibodies (aCL), lupus anticoagulant (LA), anti β2 glycoprotein I antibody (anti-β2GPI), and antibodies to phosphatidylserine-prothrombin complex (aPS/PT). Cardiovascular risk factors were assessed following NICE guidelines (1). The GAPSS system was calculated for each patient (2,3).
Nineteen patients (47.5%) had stroke, 16 (40%) a transient ischemic attack (TIA), defined as neurologic symptoms or signs lasting less than 24 hours by a neurologist. Five patients (12.5%) experienced both.. Thirty patients (75%) fulfilled the current APS classification criteria. Higher values of GAPSS were seen in patients who experienced stroke (alone or in association with TIA) when compared to those with TIA alone (10.13±3.3 [range 5-16] vs. 6.3±4.6 [range 3-13], p=0.033). This observation was confirmed when compared patients who had a history of stroke alone with patients with TIA alone (9.95±3.29 [range 5-16] vs. 6.3±4.6 [range 3-13], p=0.029). Patients who experienced both stroke and TIA showed the highest GAPSS but the difference was only statistically significant when compared to those with TIA alone (10.8±3.63 [range 7-16] vs. 6.3±4.6 [range 3-13], p=0.03).
The GAPSS is a valid tool for risk stratification for ischemic manifestation in the setting of cerebrovascular events. This tool may help identifying a more “at risk” population in whom a tailored prophylaxis therapy might be beneficial.
1. Sciascia S, Sanna G, Murru V, Roccatello D, Khamashta MA, Bertolaccini ML. GAPSS: the Global Anti-Phospholipid Syndrome Score. Rheumatology (Oxford). 2013 Aug;52(8):1397-403.
2.Excellence NIfHaC. Hypertension http://publicationsniceorguk/quality-standard-for-hypertension-qs28. 2011.
3. Excellence NIfHaC. Lipid modification. Cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease. http://guidanceniceorguk/CG/WaveR/123. 2010.
M. A. Khamashta,
M. L. Bertolaccini,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-global-antiphospholipid-syndrome-score-gapss-differentiates-between-transient-ischemic-attack-and-stroke-in-patients-with-antiphospholipid-antibodies/