Cited by 285Systemic Lupus Erythematosus ResearchVenous Thromboembolism Diagnosis and ManagementBlood Coagulation and Thrombosis Mechanisms

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Risk for venous thrombosis related to antiphospholipid antibodies in systemic lupus erythematosus—A meta-analysis

Wahl, DG, Guillemin, F., de Maistre, E., Perret, C., Lecompte, T., Thibaut, G.·1997·Lupus

DOI 10.1177/096120339700600510

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Abstract

Objective: To describe the relative risk for venous thrombosis (VT) associated with antiphos pholipid antibodies (aPL) in systemic lupus erythematosus (SLE). Design: Systematic review and meta-analysis of 26 articles that examined the association between aPL and VT in SLE. Setting: Mostly secondary and tertiary referral centres. Patients: 2249 patients with SLE, 1120 tested for LA (lupus anticoagulant) and 1563 tested for aCL (anticardiolipin antibodies). Main outcome measures: A summary of study characteristics and a critical appraisal of study quality were done. Two statistical combinations of 18 primary studies that examined the association of VT and LA and of 14 studies that examined the association of VT and aCL were performed to estimate the risk for VT associated with aPL. Results: The odds ratios of the risk of VT related to the LA summarized from 18 studies were 5.61 [95% CI; 3.80-8.27] overall, 6.32 [CI; 3.71-10.78] for deep venous thrombosis and pulmonary embolism, 11.6 [3.65--36.91] for recurrent venous thrombosis after the first event. The odds ratios of the risk of VT related to aCL summarized from 14 studies were 2.17 [95% CI; 1.51-3.11] overall, 2.50 [CI; 1.51-4.14] for deep venous thrombosis and pulmonary embolism, 3.91 [1.14- 13.38] for recurrent venous thrombosis after the first event. Conclusions: Patients with SLE and LA are at approximately six times greater risk for VT than patients without LA, whereas patients with SLE and aCL are approximately two times greater risk for VT than patients without aCL. We have identified important methodologic limitations and differences in study characteristics. Other risk factors for VT have not been thoroughly evaluated in these studies. Further studies are needed that provide an accurate estimate of the absolute risk for aPL related VT.

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Chock, Y. P. E., Moulinet, T., Dufrost, V., Erkan, D., Wahl, D. G., & Zuily, S. (2019) · Autoimmunity Reviews · doi:10.1016/j.autrev.2019.102395 · Cited by 58
Self-citation
The Clinical Spectrum of Antiphospholipid Syndrome
Baker, W., & Bick, R. L. (2008) · Hematology/Oncology Clinics of North America · doi:10.1016/j.hoc.2007.10.007 · Cited by 56
Antiphospholipid syndrome (APS) in patients with systemic lupus erythematosus (SLE) implies a more severe disease with more damage accrual and higher mortality
Riancho‐Zarrabeitia, L., Martínez-Taboada, V. M., Rúa‐Figueroa, Í., Sánchez‐Alonso, F., Galindo-Izquierdo, M., Ovalles-Bonilla, J. G., Olivé, A., Fernández‐Nebro, A., Alén, J. C., Menor-Almagro, R., et al. (2020) · Lupus · doi:10.1177/0961203320950477 · Cited by 55
Pediatric Systemic Lupus Erythematosus: More Than a Positive Antinuclear Antibody
Weiss, J. E. (2012) · Pediatrics in Review · doi:10.1542/pir.33-2-62 · Cited by 55
Thrombosis and the Antiphospholipid Syndrome
Ortel, T. L. (2005) · Hematology · doi:10.1182/asheducation-2005.1.462 · Cited by 53
Lupus in Baltimore: evidence-based ‘clinical pearls’ from the Hopkins Lupus Cohort
Petri, M. (2005) · Lupus · doi:10.1191/0961203305lu2230xx · Cited by 52
Connective Tissue Disease–Associated Lung Disease
Olson, A. L., Brown, K. K., & Fischer, A. (2012) · Immunology and Allergy Clinics of North America · doi:10.1016/j.iac.2012.09.002 · Cited by 52
Anti-cardiolipin and anti-beta 2 glycoprotein Iantibodies in Indian patients with systemic lupus erythematosus: association with the presence of seizures
Shrivastava, A., Dwivedi, S., Aggarwal, A., & Misra, R. (2001) · Lupus · doi:10.1191/096120301671577528 · Cited by 51
Are Oxidized LDL/β2‐glycoprotein I Complexes Pathogenic Antigens in Autoimmune‐mediated Atherosclerosis?
Matsuura, E., & Lopez, L. R. (2004) · Journal of Immunology Research · doi:10.1080/10446670410001722186 · Cited by 50
“Antiphospholipid antibodies appear to increase the risk of thrombosis by at least two-fold in the context of an autoimmune disease (Wahl et al., 1997).”
Background
Thrombophilia and Pregnancy
Kupferminc, M. J. (2005) · Current Pharmaceutical Design · doi:10.2174/1381612053381855 · Cited by 47
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Bertolaccini, M. L., & Khamashta, M. A. (2006) · Lupus · doi:10.1191/0961203306lu2293rr · Cited by 47
Respiratory Manifestations in Systemic Lupus Erythematosus
Bartolomeo, S. D., Alunno, A., & Carubbi, F. (2021) · Pharmaceuticals · doi:10.3390/ph14030276 · Cited by 50
“Hydroxychloroquine may reduce thrombotic risk both in APS and non-APS SLE patients due to its pleiotropic effects but evidence in this regard is still scarce [78,85].”
BackgroundInfluential
Antiphospholipid antibodies: Paradigm in transition
Horstman, L. L., Jy, W., Bidot, C., Ahn, Y. S., Kelley, R. E., Zivadinov, R., Maghzi, A. H., Etemadifar, M., Mousavi, S. A., & Minagar, A. (2009) · Journal of Neuroinflammation · doi:10.1186/1742-2094-6-3 · Cited by 46
“Galli et al acknowledge this point in the concluding sentence of their abstract [244], and others have commented similarly [262,263].”
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Nojima, J., Kuratsune, H., Suehisa, E., Kawasaki, T., Machii, T., Kitani, T., Iwatani, Y., & Kanakura, Y. (2002) · British Journal of Haematology · doi:10.1046/j.1365-2141.2002.03642.x · Cited by 44
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“Antiphospholipid syndrome (APS) is characterized by venous or arterial thromboses [1–4], obstetric morbidity [5] associated with persistent antiphospholipid antibodies (aPL) according to the Sapporo-Sydney”
BackgroundSelf-citation
Antiphospholipid (Hughes) Syndrome
Khamashta, M. A., Bertolaccini, M. L., & Hughes, G. R. V. (2004) · Autoimmunity · doi:10.1080/08916930410001708706 · Cited by 44
“A meta-analysis of APS and the risk of venous thrombosis in SLE found that patients who are LA positive were six times more likely to have such an event, and patients with aCL were two times more likely.([32])”
Background
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Matsuura, E., & Lopez, L. (2008) · Lupus · doi:10.1177/0961203308093553 · Cited by 42
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Durcan, L., & Petri, M. (2016) · Technical report · doi:10.1016/b978-0-444-63655-3.00002-8 · Cited by 43
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Khamashta, M. A. (2000) · Journal of Autoimmunity · doi:10.1006/jaut.2000.0421 · Cited by 42
Diagnosis of antiphospholipid syndrome
Bertolaccini, M. L., Khamashta, M. A., & Hughes, G. R. V. (2005) · Nature Clinical Practice Rheumatology · doi:10.1038/ncprheum0017 · Cited by 40
“A meta-analysis of APS and the risk of venous thrombosis in SLE found that patients who were LA-positive were six times more likely than patients who were LA-negative to have such an event, and patients with aCL were twice as likely as patients without aCL to have such an event”
The association of antiphospholipid antibodies with pregnancy-related first time venous thrombosis – a population-based case-control study
Bergrem, A., Jacobsen, E., Skjeldestad, F. E., Jacobsen, A. F., Skogstad, M., & Sandset, P. M. (2010) · Thrombosis Research · doi:10.1016/j.thromres.2009.12.006 · Cited by 41
“In patients with systemic lupus erythematosus and other autoimmune diseases APAs are established risk factors for VT [13,14].”
Background
Prevalence of aPhosphatidylserine/prothrombin antibodies and association with antiphospholipid antibody profiles in patients with antiphospholipid syndrome: A systematic review and meta-analysis
Zhu, R., Cheng, C., Yang, Y., Denas, G., & Pengo, V. (2022) · Thrombosis Research · doi:10.1016/j.thromres.2022.04.021 · Cited by 40
Pediatric Antiphospholipid Syndrome
Aguiar, C. L., Soybilgic, A., Avčin, T., & Myones, B. L. (2015) · Current Rheumatology Reports · doi:10.1007/s11926-015-0504-5 · Cited by 39
Anti-lysobisphosphatidic acid antibodies in patients with antiphospholipid syndrome and systemic lupus erythematosus
Alessandri, C., Bombardieri, M., Prospero, L. D., Conigliaro, P., Conti, F., Labbadia, G., Misasi, R., Sorice, M., & Valesini, G. (2005) · Clinical & Experimental Immunology · doi:10.1111/j.1365-2249.2005.02727.x · Cited by 38
Pediatric thrombosis
Hoppe, C. C., & Matsunaga, A. T. (2002) · Pediatric Clinics of North America · doi:10.1016/s0031-3955(02)00092-5 · Cited by 39
Effects of statins on thrombosis development in patients with systemic lupus erythematosus and antiphospholipid antibodies
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“It has been already well recognized that aPL increases the risk for thrombosis in SLE (32-34).”
Background
Diagnosis and management of lung involvement in systemic lupus erythematosus and Sjögren’s syndrome: a literature review
Depascale, R., Frate, G. D., Gasparotto, M., Manfrè, V., Gatto, M., Iaccarino, L., Quartuccio, L., Vita, S. D., & Doria, A. (2021) · Therapeutic Advances in Musculoskeletal Disease · doi:10.1177/1759720x211040696 · Cited by 39
“73 Indeed, thrombotic events frequently occur in the setting of antiphospholipid antibody syndrome (APS), whose prevalence in SLE is estimated to be around 30%.”
Anti-β2-Glycoprotein I Antibodies in Patients with Acute Venous Thromboembolism
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Assessment of the independent associations of IgG, IgM and IgA isotypes of anticardiolipin with thrombosis in SLE
Domingues, V., Magder, L. S., & Petri, M. (2016) · Lupus Science & Medicine · doi:10.1136/lupus-2015-000107 · Cited by 36
Thrombosis in systemic lupus erythematosus: risk and protection
Burgos, P. I., & Alarcón, G. S. (2009) · Expert Review of Cardiovascular Therapy · doi:10.1586/erc.09.137 · Cited by 34
Inherited and Acquired Thrombophilias
Rambaldi, M. P., Mecacci, F., Guaschino, S., & Paidas, M. J. (2013) · Reproductive Sciences · doi:10.1177/1933719113497282 · Cited by 35
Mechanisms of antiphospholipid-induced thrombosis: Effects on the protein C system
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Self-citation

Authors: Wahl, D., Guillemin, F., de Maistre, E., Perret, C., Lecompte, T., & Thibaut, G.
Affiliations: Service de Medicine H., Nancy University Hospital, Nancy, France
Université de Lorraine (FR)
Centre Hospitalier Régional et Universitaire de Nancy (FR)
ORCID: Guillemin, F.
de Maistre, E.
Lecompte, T.
Venue: Lupus
Publisher: SAGE Publications
Published: 1997-06
Volume: 6
Issue: 5
Pages: 467-473
ISSN: 0961-2033 (ISSN-L)
1477-0962
DOI: 10.1177/096120339700600510
OpenAlex: W2080975717
Semantic Scholar: c31dc580c59a1ad743aa46934306445622100694
Cited by: 285
References: 29
Citations by year: 2026: 3 · 2025: 3 · 2024: 11 · 2023: 8 · 2022: 6 · 2021: 10 · 2020: 10 · 2019: 9 · 2018: 4 · 2017: 10 · 2016: 11 · 2015: 7 · 2014: 5 · 2013: 11 · 2012: 5
FWCI: 1.89
Type: journal article
Language: en
Open access: closed
Licence: journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: Lupus (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
Keywords: venous thrombosis, antiphospholipid antibodies, systemic lupus erythematosus, lupus anticoagulant, anticardiolipin antibodies, deep vein thrombosis, pulmonary embolism, recurrent venous thrombosis, thrombosis risk
MeSH terms: Autoimmune Diseases, Disease Susceptibility, Epidemiologic Methods, Humans, Lupus Erythematosus, Systemic, Risk, Thrombophlebitis, Comorbidity, Odds Ratio, Single-Blind Method, Lupus Coagulation Inhibitor, Antiphospholipid Syndrome, Antibodies, Antiphospholipid, Antibodies, Anticardiolipin

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Risk for venous thrombosis related to antiphospholipid antibodies in systemic lupus erythematosus—A meta-analysis

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