Increased mortality in patients with the lupus anticoagulant: the Vienna Lupus Anticoagulant and Thrombosis Study (LATS)
Abstract
Data on the clinical course of lupus anticoagulant (LA)-positive individuals with or without thrombotic manifestations or pregnancy complications are limited. To investigate mortality rates and factors that might influence mortality, we conducted a prospective observational study of LA-positive individuals. In total, 151 patients (82% female) were followed for a median of 8.2 years; 30 of the patients (20%) developed 32 thromboembolic events (15 arterial and 17 venous events) and 20 patients (13%) died. In univariable analysis, new onset of thrombosis (hazard ratio [HR] = 8.76; 95% confidence interval [CI], 3.46-22.16) was associated with adverse survival. Thrombosis remained a strong adverse prognostic factor after multivariable adjustment for age and hypertension (HR = 5.95; 95% CI, 2.43-14.95). Concomitant autoimmune diseases, anticoagulant treatment at baseline, or positivity for anticardiolipin- or anti-β2-glycoprotein I antibodies were not associated with mortality. In a relative survival analysis, our cohort of LA positives showed a persistently worse survival in comparison with an age-, sex-, and study-inclusion-year-matched Austrian reference population. The cumulative relative survival was 95.0% (95% CI, 88.5-98.8) after 5 years and 87.7% (95% CI, 76.3-95.6) after 10 years. We conclude that occurrence of a thrombotic event is associated with higher mortality in patients with LA. Consequently, the prevention of thromboembolic events in LA positives might improve survival.
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LA is the best-established risk factor for clinical manifestations related to antiphospholipid syndrome.
“LA is the best-established risk factor for APS-related clinical manifestations.[5][6][7][8][9]”
The occurrence of thrombosis in patients with LA is associated with an excessive increase in the risk of death, leading to impaired relative survival compared to an age- and sex-matched reference population.
“Cervera et al. and our group have recently demonstrated that the occurrence of thrombosis in patients with LA is associated with an excessive increase in the risk of death, which in turn leads to a significantly impaired relative survival of these patients in comparison to an age- and sex-matched reference population [5, 6].”
From Cardiovascular risk factors are major determinants of thrombotic risk in patients with the lupus anticoagulant (2017) · cites this paper as [5]
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 [29]
In a LAC-positive population, the association between occurrence of thrombosis and mortality was independent of anti-CL and antiβ2GPI antibodies.
“A prospective study showed that in a LAC-positive population the association between occurrence of thrombosis and mortality was independent of anti-CL and antiβ 2GPI antibodies. 15”
From Clinical Relevance of Isolated Lupus Anticoagulant Positivity in Patients with Thrombotic Antiphospholipid Syndrome (2021) · cites this paper as [15]
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“Amongst our demographic and clinical factors, age, sex, age at 1st event and number of thrombosis were not associated with the risk of death, contrary to other reports (27); we also explored the possible contribution of MTHFR and PON genotypes.”
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“A recent prospective observational study in 151 LA-positive individuals also found LA positivity to be associated with increased mortality, independent of concomitant positivity for anticardiolipin or anti-β2GPI.(19) In contrast, Pengo et al(20) recently reported that the risk of thromboembolic events was low in a pro…”
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“[33] Our study has several potential limitations.”
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“68 VKA monitoring may be unreliable in a subset of patients leading to inadequate anticoagulation, considering the effects of LA on the INR despite apparent therapeutic INRs.”
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“In addition, the presence of LA is a well-known risk factor for clinical manifestations of APS patients[3 – 5].”
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“Konsekutiv sollten Patienten mit LAPositivität ebenfalls als Hochrisikopatienten eingestuft werden [9].”
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“[23] However, the determination of LA is impaired by the presence of anticoagulant therapy.”
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- Authors
- Gebhart, J., Posch, F., Koder, S., Perkmann, T., Quehenberger, P., Zoghlami, C., Ay, C., & Pabinger, I.
- Affiliations
- Department of Medicine I, Clinical Division of Hematology and Hemostaseology; and
- Medical University of Vienna (AT)
- Venue
- Blood
- Publisher
- American Society of Hematology
- Published
- 2015-05-28
- Volume
- 125
- Issue
- 22
- Pages
- 3477-3483
- ISSN
- 0006-4971 (ISSN-L)
- 1528-0020
- OpenAlex
- W2023431216
- Cited by
- 72
- References
- 42
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 8 · 2023: 6 · 2022: 4 · 2021: 6 · 2020: 15 · 2019: 5 · 2018: 3 · 2017: 6 · 2016: 7 · 2015: 5
- FWCI
- 5.17
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Blood (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
- lupus anticoagulant, mortality, thrombosis, thromboembolic events, survival, prognostic factors, arterial thrombosis, venous thrombosis
- MeSH terms
- Adult, Anticoagulants, Austria, Cause of Death, Female, Follow-Up Studies, Humans
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