Antiphospholipid antibodies and thrombosis: association with acquired activated protein C resistance in venous thrombosis and with hyperhomocysteinemia in arterial thrombosis

Jeannine Kassis; Carolyn Neville; Joyce Rauch; Lambert Busque; Erika R. Chang; Lawrence Joseph; Martine Le Comte; Rebecca Subang; Paul R. Fortin

doi:10.1160/TH04-03-0138

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2004; 92(06): 1312-1319
DOI: 10.1160/TH04-03-0138

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Antiphospholipid antibodies and thrombosis: association with acquired activated protein C resistance in venous thrombosis and with hyperhomocysteinemia in arterial thrombosis

Jeannine Kassis

¹Department of Hematology, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Quebec, Canada

,

Carolyn Neville

²Division of Clinical Epidemiology, The Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada

,

Joyce Rauch

³Division of Rheumatology, The Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada

,

Lambert Busque

¹Department of Hematology, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Quebec, Canada

,

Erika R. Chang

⁴Division of Outcomes and Population Health, University Health Network, University of Toronto, Toronto, Ontario, Canada

,

Lawrence Joseph

²Division of Clinical Epidemiology, The Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada

⁵Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada

,

Martine Le Comte

²Division of Clinical Epidemiology, The Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada

,

Rebecca Subang

³Division of Rheumatology, The Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada

,

Paul R. Fortin

⁴Division of Outcomes and Population Health, University Health Network, University of Toronto, Toronto, Ontario, Canada

⁶Division of Rheumatology, University Health Network, University of Toronto, Toronto, Ontario, Canada

› Author Affiliations

Abstract

Summary

Although antiphospholipid antibodies (aPL) are associated with thrombosis, it is not known who with aPL is at higher risk for thrombosis. It was the aim of this cross-sectional study to investigate how thrombophilic factors contribute to venous or arterial thrombosis in aPL-positive individuals. In outpatient test centres at two tertiary care hospitals, two hundred and eight (208) persons requiring aPL testing were matched by age, gender and centre to 208 persons requiring a complete blood count. Persons were classified as aPL-positive (having anticardiolipin, lupus anticoagulant and/or anti-β₂-glycoprotein I antibodies) or aPL-negative. Several thrombophilic factors were studied using logistic regression modelling. Results showed that the aPL-positive group had three-fold more events (37%) than the aPL-negative group (12%). In unadjusted analyses, clinically important associations were observed between factor V Leiden and venous thrombosis, hyperhomocysteinemia and arterial thrombosis, and activated protein C resistance (APCR) and venous thrombosis (OR, 95% CI = 4.00, 1.35-11.91; 4.79, 2.03-11.33; and 2.03, 1.03-3.97, respectively). After adjusting for recruitment group, persons with both APCR and aPL had a three-fold greater risk (OR, 95% CI = 3.31, 1.30-8.41) for venous thrombosis than those with neither APCR nor aPL. Similarly, after adjusting for hypertension, family history of cardiovascular disease, gender and recruitment group, persons with both hyperhomocysteinemia and aPL had a five-fold increased risk (OR, 95% CI = 4.90, 1.37-17.37) for arterial thrombosis compared to those with neither risk factor. In conclusion, APCR phenotype and hyperhomocysteinemia are associated with a higher risk of venous and arterial thrombosis, respectively, in the presence of aPL.

Keywords

Antiphospholipid antibodies - antiphospholipid syndrome - thrombosis - activated protein C resistance - hyperhomocysteinemia

Full Text

References

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