Session Information
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose:
To estimate the rate and predictors of venous thromboembolic events (VTEs) in a population-based cohort of patients with ANCA- associated vasculitis (AAV).
Methods:
322 patients (47% women) diagnosed with AAV between 1997 and 2016 from a well-defined population in southern Sweden, were included in this study. The diagnosis of AAV and VTEs were ascertained by review of medical records. Radiological investigations, clinical notes, laboratory results and prescriptions of anticoagulation therapies were reviewed to identify patients with VTEs. Demographics, clinical and laboratory data were collected from time of AAV diagnosis until death or end of follow-up, September 2017. Birmingham Vasculitis Activity Score (BVAS) was used to assess AAV disease activity. Organ damage was assessed by vasculitis damage index (VDI). VTEs occurred within 3 months prior to AAV diagnosis and any time after that were considered as AAV-related VTEs.
Results:
55 patients (17%) developed a total of 63 VTEs of which 31 cases were deep vein thrombosis, 21 pulmonary embolisms and 11 other VTEs (5 retinal vein thrombosis, 1 sinus thrombosis, 1 subclavian vein thrombosis, 2 cases of jugular vein thrombosis, 1 right ventricle thrombosis, 1 olecranon bursa vein thrombosis). Of all patients with VTEs, 45 (82%) developed AAV-related VTE resulting in an incidence rate of 2.4/100 person-years (95% CI 1.7-3.1) during 1906 person-year of follow-up. The incidence rate of AAV-related VTEs during first year from diagnosis of AAV was estimated to 10.9/100 person-year (95% CI 6.8-14.9), decreased to 6.2 at 2-years (p=0.07), 3.9 at 5-years (p<0.001) and 2.8 at 10 years from diagnosis of AAV (p<0.001). The incidence rate of VTEs /100 person-year in patients with positive MPO-ANCA was 3.3 (95% CI 2-4.7) vs. 2.1 (95% CI 1.2-3.0) in patients with PR3-ANCA, p=0.1. Patients who developed any VTE were older at diagnosis and had higher BVAS score, were more likely to be MPO-ANCA positive and had higher VDI at 12 months after diagnosis of AAV (Table 1).
Conclusion:
Higher age at diagnosis of the vasculitis, MPO positivity and high disease activity were associated with VTEs. The incidence rate of AAV-related VTEs was higher early at disease onset compared to the whole period of follow-up.
Table 1. VTEs in 322 patients with ANCA Associated Vasculitis
|
All patients (n=322) |
VTEs (n=55) |
No VTEs (n=267) |
P-value |
|
|
Age at diagnosis, mean ±SD, years. |
64.4 ±16.4 |
68.8 ±13.9 |
63.5 ±16.8 |
0.03 |
|
Sex, Female, n (%) |
150 (47) |
23 (42) |
127 (48) |
0.4 |
|
Diagnosis: GPA: MPA: EGPA |
166: 134: 22 |
26: 27: 2 |
140: 107: 20 |
|
|
PR3-ANCA +, n (%) |
156 (51) |
21 (41) |
135 (54) |
0.1 |
|
MPO-ANCA +, n (%) |
138 (45) |
32 (62) |
106 (42) |
0.01 |
|
BVAS at diagnosis, mean ±SD |
15.3 ±6.2 |
17.1 ±7 |
14.6 ±6 |
0.009 |
|
Laboratory data at diagnosis |
||||
|
S-creatinine, μmol/l, median (IQR) |
136 (74-308) |
190 (76-355) |
128 (73-283) |
0.1 |
|
Haemoglobin, g/l mean ±SD |
110 ±20 |
110 ±17 |
110 ±20 |
0.8 |
|
White blood cell count, mean ±SD |
12 ±4.9 |
12 ±5.4 |
12 ±4.8 |
0.7 |
|
Platelet count mean ±SD |
370 ±144 |
343 ±144 |
375 ±144 |
0.1 |
|
CRP, mg/l, median (IQR) |
77 (23-134) |
53 (11-121) |
83 (26-143) |
0.2 |
|
ESR, mm/hr, mean ±SD |
64 ±33 |
62 ±30 |
64 ±34 |
0.8 |
|
eGFR ml/min/1.7m2, median (IQR) |
44 (18-86) |
30 (15-82) |
47 (17-87) |
0.3 |
|
Deaths, n (%) |
144 (45) |
28 (51) |
116 (43) |
0.3 |
|
ESRD, n (%) |
51 (16) |
9 (16) |
42 (16) |
0.9 |
|
BVAS at 12 months, mean ±SD |
0.8 ±2.5 |
0.7 ±2.1 |
0.9 ±2.4 |
0.7 |
|
VDI, at 12 months, median (IQR) |
1 (0-2) |
2 (1-3) |
1 (0-2) |
0.1 |
GPA: granulomatosis with polyangiitis, MPA: microscopic polyangiitis, EGPA: eosinophil granulomatosis with polyangiitis, PR3: proteinase-3, MPO: myeloperoxidase, BVAS: Birmingham Vasculitis Activity Score, IQR: interquartile range, CRP: c-reactive protein, ESR: erythrocyte sedimentation rate eGFR: estimated glomerular filtration rate at disease onset, ESRD: end-stage renal disease, VDI: vasculitis damage index.
To cite this abstract in AMA style:
Liapi M, Jayne D, Segelmark M, Mohammad A. Venous Thromboembolism in ANCA Associated Vasculitis. a Population-Based Cohort Study from Southern Sweden [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/venous-thromboembolism-in-anca-associated-vasculitis-a-population-based-cohort-study-from-southern-sweden/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/venous-thromboembolism-in-anca-associated-vasculitis-a-population-based-cohort-study-from-southern-sweden/