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Cited by 330Systemic Lupus Erythematosus ResearchBlood Coagulation and Thrombosis MechanismsVasculitis and related conditions

A cross-sectional study of clinical thrombotic risk factors and preventive treatments in antiphospholipid syndrome

Erkan, D.·2002·Rheumatology
DOI 10.1093/rheumatology/41.8.924
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Abstract

OBJECTIVE: Antiphospholipid antibodies (aPL) are major risk factors for thrombosis. Other clinical factors exist in antiphospholipid syndrome (APS) patients which may have an additive or preventive effect on thrombosis. We therefore performed a cross-sectional study to analyse additive clinical thrombotic risk factors and possible preventive treatments in APS patients, and to compare the results with those obtained in asymptomatic aPL-positive (no history of vascular thrombosis or pregnancy morbidity) patients. METHODS: We identified 77 APS patients with non-gravid thrombotic events (group A) and 56 asymptomatic aPL-positive patients (group B). The study periods were defined as 6 months prior to the time of first vascular event in group A and 6 months prior to the patient's last visit in group B. Medical records were reviewed to evaluate the incidence of hypertension, diabetes mellitus, hypercholesterolaemia, regular cigarette smoking, oral contraceptive use or hormone replacement therapy, surgical procedures, pregnancy with or without an APS-related event, malignancy and infections. In addition, any history of thrombocytopenia or the use of aspirin, hydroxychloroquine, corticosteroids or immunosuppressives during the study periods was recorded. Bivariate statistical analysis and logistic regression tests were performed to compare groups. RESULTS: In group A, 75% (n=58) of patients and in group B 48% (n=27) of patients had at least one of the additional risk factors during the study periods. In the bivariate analysis, pregnancy (P=0.005) and surgical procedures (P=0.04) were significantly more frequent in group A, while aspirin (P<0.001), hydroxychloroquine (P<0.001) and corticosteroids (P=0.002) were used significantly more frequently in group B. In logistic regression, the probability of an event was decreased by taking aspirin and/or hydroxychloroquine. In women only, the probability of an event was increased with thrombocytopenia and pregnancy or surgical procedures. The incidences of hypertension and smoking and the presence of more than one risk factor were significantly associated with arterial thrombosis but not venous thrombosis. CONCLUSION: While traditional risk factors were similar between groups, pregnancy and surgical procedures increased the risk of thrombosis. Hypertension and smoking were associated with arterial events. Possessing a combination of risk factors may increase the occurrence of arterial thrombosis but not venous thrombosis. Use of aspirin and/or hydroxychloroquine may be protective against thrombosis in asymptomatic aPL-positive individuals.

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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 [10]

    The Discussion states that hydroxychloroquine reduces thrombosis risk in SLE patients, supporting the central point. It does not specify reduced risk for both arterial and venous thrombosis in SLE or identify the supporting studies as retrospective and prospective; this paper’s own study is cross-sectional. (LLM, conf=0.84)

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Research works printed but not linked: 4

  1. Jacobs BS, Levine SR. Antiphospholipid antibody syndrome. Curr Treat Options Neurol 2000;2:449-58.
  2. Erkan D, Merrill JT, Yazici Y, Sammaritano L, Buyon JP, Lockshin MD. High thrombosis rate after fetal loss in antiphospholipid syndrome-effective prophylaxis with aspirin. Arthritis Rheum 2001;44:1466-7.
  3. Edwards MH, Pierangeli S, Liu X et al. Hydroxychloro- quine reverses thrombogenic properties of antiphospho- lipid antibodies in mice. Circulation 1997;96:4380-84.
  4. Qushmaq K, Esdaile J, Devine DV. Thrombosis in systemic lupus erythematosus: the role of antiphospholipid antibody. Arthritis Care Res 1999;12:212-9.

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Authors
Erkan, D.
Affiliations
Hospital for Special Surgery (US)
Corresponding author
Erkan, D.
ORCID
Erkan, D.
Venue
Rheumatology
Publisher
Oxford University Press (OUP)
Published
2002-08-01
Volume
41
Issue
8
Pages
924-929
ISSN
  • 0263-7103 (ISSN-L)
  • 1460-2172
DOI
10.1093/rheumatology/41.8.924
OpenAlex
W2125189646
Cited by
330
References
36
Citations by year
2026: 4 · 2025: 4 · 2024: 7 · 2023: 12 · 2022: 2 · 2021: 12 · 2020: 12 · 2019: 11 · 2018: 14 · 2017: 11 · 2016: 21 · 2015: 12 · 2014: 15 · 2013: 18 · 2012: 30
FWCI
7.80
Type
journal article
Language
en
Open access
closed
Locations
  • British journal of rheumatology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
  • Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Vasculitis and related conditions
Keywords
antiphospholipid syndrome, thrombosis, thrombosis risk factors, antiphospholipid antibodies, pregnancy, surgical procedures, hypertension, smoking, arterial thrombosis, venous thrombosis, thromboprophylaxis, aspirin, hydroxychloroquine, corticosteroids, thrombocytopenia, diabetes mellitus
MeSH terms
Cross-Sectional Studies, Diabetes Mellitus, Female, Humans, Hypercholesterolemia, Hypertension, Infections, Male, Middle Aged, Neoplasms, Pregnancy, Risk Factors, Smoking, Thrombocytopenia, Thrombosis, Estrogen Replacement Therapy, Antiphospholipid Syndrome, Patient Selection

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