Risk and protective factors for thrombosis in systemic lupus erythematosus: results from a large, multi-ethnic cohort
Open accessAbstract
Objectives Few studies have examined thrombosis in systemic lupus erythematosus (SLE), none have included Asian-Americans, and most have had small sample sizes. We analysed risk factors for thrombosis in a large, multi-ethnic SLE cohort.Methods We studied 1930 SLE subjects, including Caucasians, African-Americans, Asian-Americans and Hispanics. Data were derived from questionnaires and medical records. Documented history of thrombosis was the primary outcome. Explanatory variables included age at SLE diagnosis, gender, ethnicity, disease duration, smoking, antiphospholipid antibody (aPL) status, nephritis and specific medications.Results Smoking (OR 1.26, p = 0.011), longer disease duration (OR 1.26 per 5 years p = 0.027 x 10(-7)), nephritis (OR 1.35, p = 0.036), aPL positivity (OR 3.22, p<10(-9)) and immunomodulating medication use (OR 1.40, p = 0.011) were statistically significant risk factors for thrombosis. Younger age at SLE onset was protective (OR 0.52 for age </=20, p = 0.001). After adjusting for disease severity and incorporating propensity scores, hydroxychloroquine use remained significantly protective for thrombosis (OR 0.62, p = 4.91 x 10(-4)).Conclusions This study confirms that older age at onset, longer disease duration, smoking, aPL positivity, history of nephritis and immunomodulating medication use are risk factors for thrombosis in SLE. These data are the first to confirm in a large and ethnically diverse SLE cohort that hydroxychloroquine use is protective for thrombosis.
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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 [6]
The Results report that hydroxychloroquine use was associated with lower overall thrombosis risk in an SLE cohort. The Patients and Methods section includes arterial and venous events, but our copy does not report a separate hydroxychloroquine finding for each type. The Discussion describes this study as retrospective and says the association needs testing in prospective randomised trials, so this source does not establish the claim about prospective studies. (LLM, conf=0.86)
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- Authors
- Kaiser, R., Cleveland, C. M., & Criswell, L. A.
- Affiliations
- University of California, San Francisco (US)
- Corresponding author
- Criswell, L A
- ORCID
- Criswell, L A
- Venue
- Annals of the Rheumatic Diseases
- Publisher
- Elsevier BV
- Published
- 2009-02
- Volume
- 68
- Issue
- 2
- Pages
- 238-241
- ISSN
- 0003-4967 (ISSN-L)
- PMC
- PMC2875136
- OpenAlex
- W2132053014
- Cited by
- 244
- References
- 20
- Citations by year
- 2026: 6 · 2025: 10 · 2024: 12 · 2023: 11 · 2022: 11 · 2021: 14 · 2020: 19 · 2019: 14 · 2018: 9 · 2017: 8 · 2016: 19 · 2015: 9 · 2014: 18 · 2013: 18 · 2012: 22
- FWCI
- 10.16
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Annals of the Rheumatic Diseases (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- National Institutes of Health (5m01rr000079-42)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (K24-AR-02175, P60AR053308, R01 AR22804, K24AR002175, P60 AR0533008)
- National Center for Research Resources (5M01-RR00079, M01-RR000079)
- 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
- systemic lupus erythematosus, thrombosis, thrombosis risk factors, protective factors, antiphospholipid antibodies, smoking, nephritis, disease duration, age of onset, hydroxychloroquine, Asian Americans, multi-ethnic cohort
- MeSH terms
- Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, California, Child, Female, Humans, Hydroxychloroquine, Immunosuppressive Agents, Lupus Erythematosus, Systemic, Lupus Nephritis, Male, Middle Aged, Risk Factors, Sex Factors, Smoking, Thrombosis, Young Adult
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