Risk factors for thrombosis and primary thrombosis prevention in patients with systemic lupus erythematosus with or without antiphospholipid antibodies
Abstract
Objective: Antiphospholipid antibodies (aPL), namely anticardiolipin antibodies (aCL) and lupus anticoagulant (LAC), have been associated with an increased risk of thrombosis in systemic lupus erythematosus (SLE). We examined additional thrombosis risk factors (aPL profile, SLE‐related, and traditional risk factors) and the primary thrombosis prevention in SLE patients with and without aPL. Methods: All SLE patients with positive aPL but without previous thrombotic manifestations who were regularly followed up at our department (n = 144) and 144 age‐ and sex‐matched SLE patients with negative aPL were included in this study. The median followup times were 104 and 112 months, respectively. The demographic, clinical, laboratory, and treatment characteristics and the traditional thrombosis risk factors were recorded. Results: The thrombosis rate was 29 per 144 aPL‐positive patients (20.1%) and 11 per 144 aPL‐negative patients (7.6%; P = 0.003). In multiadjusted analysis, significant predictors of thrombosis were male sex (hazard ratio [HR] 6.25, P < 0.01), LAC (HR 3.48, P = 0.04), and constantly positive aCL (HR 5.87, P = 0.01) for aPL‐positive patients, while male sex (HR 7.14, P = 0.03) and hypertension were predictors for aPL‐negative patients (HR 6.49, P = 0.03). Additionally, the duration of low‐dose aspirin treatment played a protective role against thrombosis in aPL‐positive patients (HR per month 0.98, P = 0.05), as did the duration of hydroxychloroquine in both aPL‐positive (HR per month 0.99, P = 0.05) and aPL‐negative patients (HR per month 0.98, P = 0.04). Conclusion: Independent predictors of thrombosis for aPL‐positive patients were male sex, LAC, and constantly positive aCL, and for aPL‐negative patients were male sex and hypertension. The duration of low‐dose aspirin use played a protective role against thrombosis in aPL‐positive patients as did the duration of hydroxychloroquine in both groups.
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Prior retrospective and prospective studies have shown that hydroxychloroquine lowers the risk of arterial and venous thrombosis in systemic lupus erythematosus.
“Multiple retrospective and a few prospective studies (3–13) have found that hydroxychloroquine (HCQ) reduces the risk of arterial and venous thrombosis.”
From Association of Higher Hydroxychloroquine Blood Levels With Reduced Thrombosis Risk in Systemic Lupus Erythematosus (2021) · cites this paper as [9]
Some studies reported that the increased risk of thrombosis in SLE was associated with the presence of LA and with a persistently positive aCL.
“Some studies reported that the increased risk of thrombosis in SLE was associated with the presence of LA and with a persistently positive aCL [41, 44].”
From Antiphospholipid patterns predict risk of thrombosis in systemic lupus erythematosus (2021) · cites this paper as [44]
In systemic lupus erythematosus patients with a low-risk antiphospholipid antibody profile, pooled data from two cohort studies indicate that low-dose aspirin is associated with a lower risk of thrombosis.
“Less evidence is available on the use of LDA in patients with SLE and low-risk aPL profile, but pooled data from two cohort studies indicate that the use of LDA was also associated with a lower risk of thrombosis in this group.16 17”
From EULAR recommendations for the management of antiphospholipid syndrome in adults (2019) · cites this paper as [17]
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- Authors
- Tektonidou, M. G., Laskari, K., Panagiotakos, D. B., & Moutsopoulos, H. M.
- Affiliations
- National and Kapodistrian University of Athens (GR)
- Harokopio University of Athens (GR)
- Venue
- Arthritis Care & Research
- Publisher
- Wiley
- Published
- 2008-12-30
- Volume
- 61
- Issue
- 1
- Pages
- 29-36
- ISSN
- 0893-7524 (ISSN-L)
- 1529-0123
- OpenAlex
- W2050117403
- Cited by
- 356
- References
- 55
- Citations by year
- 2026: 8 · 2025: 11 · 2024: 27 · 2023: 23 · 2022: 20 · 2021: 18 · 2020: 28 · 2019: 19 · 2018: 23 · 2017: 19 · 2016: 31 · 2015: 15 · 2014: 19 · 2013: 19 · 2012: 24
- FWCI
- 11.97
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Arthritis Care & Research (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Keywords
- systemic lupus erythematosus, antiphospholipid antibodies, anticardiolipin antibodies, lupus anticoagulant, thrombosis risk factors, low-dose aspirin, hydroxychloroquine, hypertension, male sex, thrombosis incidence, lupus nephritis, antiphospholipid syndrome, thromboprophylaxis, lupus vasculitis
- MeSH terms
- Adolescent, Adult, Anti-Inflammatory Agents, Non-Steroidal, Aspirin, Female, Follow-Up Studies, Humans, Hydroxychloroquine, Lupus Erythematosus, Systemic, Male, Risk Factors, Sex Characteristics, Thrombosis, Multivariate Analysis, Lupus Coagulation Inhibitor, Antibodies, Antiphospholipid, Antirheumatic Agents, Young Adult
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