ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2759

The Risk of Ischaemic Stroke in Primary APS Patients: A Prospective Study

Massimo Radin1, Karen Schreiber2, Irene Cecchi3, Dario Roccatello4, Maria Jose Cuadrado5 and Savino Sciascia6, 1Department of Clinical and Biological Sciences, Center of Research of Immunopathology and Rare Diseases- Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, University of Turin, Italy, Turin, Italy, 2Department of Thrombosis and Haemophilia, Guy's and St Thomas' Hospital, London, United Kingdom., London, United Kingdom, 3Center of Research of Immunopathology and Rare Diseases- Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, University of Turin, Italy, Turin, Italy, 4Center of Research of Immunopathology and Rare Diseases- Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, University of Turin and S. Giovanni Bo, Turin, Italy, 5St Thomas Hospital, Lupus Research Unit, London, United Kingdom, 6Center of Research of Immunopathology and Rare Diseases- Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, University of Turin, Italy, Center of Research of Immunopathology and Rare Diseases- Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, University of Turin, Italy, Torino, Italy

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: , , ,

Session Information

Date: Tuesday, November 7, 2017

Title: Antiphospholipid Syndrome

Session Type: ACR Concurrent Abstract Session

Session Time: 2:30PM-4:00PM

Background/Purpose:

The antiphospholipid syndrome(APS)is an autoimmune condition characterized by thrombosis and/or pregnancy morbidity andpersistent positivityfor antiphospholipid antibodies(aPL). The most common neurological manifestation of APS is ischaemic stroke(1). Identifying patients with APS at high risk for developing any thrombotic eventremains a major challenge. In this study, we aimed to identify predictive factors of ischaemic stroke in a cohort of primary APS (PAPS) patientswho presented with new onset symptoms suggestive of acute stroke.

Methods:

This prospective multicenter study included 36 consecutive PAPS patients[mean age 32 years old(SD33·7),female(86%)] who presented with new onset symptoms suggestive of an acute stroke.Data on cardiovascular risk factors and aPL positivity were collected and aGAPSS score was calculated.Patients were prospectively followedup for 12 months. Demographic, clinical and laboratory characteristics are summarized in Table 1 and Table 2.

Results:

In ten(28%) out of 36 PAPS patients[mean age 41 years old(SD13·4), female(70%)], the suspicion of an acute stroke was confirmed by brainMRI. Sixty percent of these patients were<50years old. Six out of the ten patients had a history of previous venous thrombosis and were receiving vitamin K antagonist(VKA), with INR target 2-3;one patient had a history of a previousarterial event receiving treatment with VKA targetINR2-3 plus low dose aspirin(LDA), and one patient had a history of previous pregnancy morbidity receiving only LDA. Time in therapeutic range for patients receiving VKA was 77·7(S.D.6·6). Hypercholesterolemia was significantly higher in patients with confirmed stroke when compared to those without(p<0·05). Similarly, we found a significantly higher rate of anti-ß2GPI antibodies(IgG/IgM)(p<0·05) and higher aGAPSS values in patients with a confirmed stroke[mean aGAPSS 8·9 (S.D.4·7)Vs. mean aGAPSS6·4(S.D.2·5);p:<0·05].

Conclusion:

Patients with PAPS,including young patients, have a high risk of recurrent thrombosis despite anticoagulation treatment. A careful risk assessment is mandatory to identify patients at risk for recurrence. Modifiable risk factor reduction may be a first step to prevent recurrence.

References:

1. Muscal E, Brey RL. Neurologic manifestations of the antiphospholipid syndrome: integrating molecular and clinical lessons. Curr Rheumatol Rep 2008;10:67–73.

Table 1

Patients Characteristics

All (n=36)

%

Female sex

31

86

Age, mean (S.D.), years

32 (33,7)

Age <50 years

25

69

Age <40 years

15

42

Caucasians, n

31

86

Stroke

10

28

Small vessel changes

8

22

Hyperintensive lesions increased for age

5

14

Haematoma

1

3

PAPS, n

36

100

Arterial Hypertension, n

9

25

Hyperlipidemia, n

7

19

LA, n

33

92

aCL IgG/M, n

12

33

Anti-Beta2GPI IgG/IgM, n

6

17

Triple aPL positivite

4

11

Table 2

Stroke (10)

No stroke (26)

p (Chi Square test)

Age (mean, SD)

43,4 ±10,4

39,2 ±12,5

Sex (females)

7 (70%)

23 (88%)

0.183

Hyperlipidemia

6 (60%)

3 (12%)

<0.05

Arterial Hypertension

4 (30%)

3 (12%)

0.075

LA

9 (90%)

24 (92%)

1.00

aCL IgG/M

3 (30%)

9 (35%)

1.00

Anti-Beta2GPI IgG/IgM

5 (50%)

1 (4%)

<0.05

Triple aPL positivity

2 (20%)

2 (8%)

0 .305

Disclosure: M. Radin, None; K. Schreiber, None; I. Cecchi, None; D. Roccatello, None; M. J. Cuadrado, None; S. Sciascia, None.

To cite this abstract in AMA style:

Radin M, Schreiber K, Cecchi I, Roccatello D, Cuadrado MJ, Sciascia S. The Risk of Ischaemic Stroke in Primary APS Patients: A Prospective Study [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/the-risk-of-ischaemic-stroke-in-primary-aps-patients-a-prospective-study/. Accessed .

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