Risk of venous and arterial thrombosis according to type of antiphospholipid antibodies in adults without systemic lupus erythematosus: a systematic review and meta-analysis
Abstract
Aim To evaluate the magnitude of venous and arterial thrombosis risk associated with antiphospholipid antibodies (APLs) in adults without systemic lupus erythematosus (SLE).Methods Case-control and cohort studies were selected from the MEDLINE and Cochrane Library databases. Two investigators independently extracted data on study design, patient characteristics, venous and arterial events and exposure to APLs, including lupus anticoagulant (LA), anticardiolipin (aCL), anti-β2 Glycoprotein I (β2GpI), anti-prothrombin (aPT), anti-phosphatidyl serine (aPS), and anti-phosphatidyl ethanolamine (aPE).Results 30 studies were included (16,441 patients). The odds ratio (OR) for venous thrombosis was 6.14 (95% confidence interval [CI] 2.74-13.8) in LA-positive patients (5 studies, 1650 patients) and 1.46 (CI 1.06-2.03) in aCL-positive patients (12 studies, 5375 patients). None of the associations with more recently identified APLs was significant, but fewer studies were available. For arterial thrombosis, the OR for LA and aCL was 3.58 (CI 1.29-9.92) and 2.65 (CI 1.75-4.00) respectively. The associations between β2GpI, aPT and aPS and the risk of arterial thrombosis were also significant, the OR being 3.12 (CI 1.51-6.44), 2.95 (CI 1.31-6.66) and 6.00 (CI 3.07-11.7), respectively. Owing to the heterogeneity of cut-off values for each APL assay, we were unable to perform any sensitivity analysis to determine the optimal value. The presence of low-quality studies may have led to overestimation of the magnitude of the associations.Conclusions LA and aCL were significantly associated with an increased risk of thrombosis, especially arterial, in patients without SLE. Systematic thromboprophylaxis in high-risk patients with APL should be evaluated.
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In most studies, in SLE, LA is the main predictor of thrombosis.
“In most studies, it has been shown that in SLE, LA is the main predictor of thrombosis [9, 27–29].”
From Antiphospholipid patterns predict risk of thrombosis in systemic lupus erythematosus (2021) · cites this paper as [27]
Most prior efforts to risk-stratify patients for future thrombotic events have used aPL status from the first measurement or early in observation and have not analyzed changes over time.
“Notably, most prior efforts to risk-stratify patients for future thrombotic events have used the patients’ aPL status from the first measurement or early in the observation period and have not analyzed changes over time.3,7,8”
From Lupus anticoagulant test persistence over time and its associations with future thrombotic events (2022) · cites this paper as [7]
A positive LAC is a strong risk factor for thrombosis in APS.
“Although a positive LAC is considered to be a strong risk factor for thrombosis in APS, 10,11”
From Clinical Relevance of Isolated Lupus Anticoagulant Positivity in Patients with Thrombotic Antiphospholipid Syndrome (2021) · cites this paper as [11]
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- Authors
- Reynaud, Q., Lega, J.-C., Mismetti, P., Chapelle, C., Wahl, D., Cathébras, P., & Laporte, S.
- Affiliations
- Centre Hospitalier Universitaire de Saint-Étienne (FR)
- Lyon 1 Université (FR)
- Inserm (FR)
- Corresponding author
- Lega, Jean-Christophe
- ORCID
- Venue
- Autoimmunity Reviews
- Publisher
- Elsevier BV
- Published
- 2014-06
- Volume
- 13
- Issue
- 6
- Pages
- 595-608
- ISSN
- 1568-9972 (ISSN-L)
- OpenAlex
- W2020778344
- Cited by
- 179
- References
- 68
- Citations by year
- 2026: 5 · 2025: 10 · 2024: 16 · 2023: 1 · 2022: 12 · 2021: 13 · 2020: 19 · 2019: 15 · 2018: 21 · 2017: 19 · 2016: 18 · 2015: 22 · 2014: 8
- FWCI
- 3.68
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Autoimmunity Reviews (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- 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
- antiphospholipid antibodies, venous thrombosis, arterial thrombosis, lupus anticoagulant, anticardiolipin antibodies, anti-beta2-glycoprotein I antibodies, anti-prothrombin antibodies, antiphosphatidylserine antibodies, thrombosis risk, thromboprophylaxis
- MeSH terms
- Adult, Humans, Lupus Erythematosus, Systemic, Risk Factors, Thrombosis, Cohort Studies, Case-Control Studies, Lupus Coagulation Inhibitor, Antiphospholipid Syndrome, Antibodies, Antiphospholipid, beta 2-Glycoprotein I
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