Incidence of a first thromboembolic event in asymptomatic carriers of high-risk antiphospholipid antibody profile: a multicenter prospective study
Incidence of a first thromboembolic event in asymptomatic carriers of high-risk antiphospholipid antibody profile: a multicenter prospective study
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DOI：
10.1182/blood-2011-03-340232
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发表时间：
2011-10-27
期刊：
影响因子：
20.3
通讯作者：
Iliceto, Sabino
中科院分区：
文献类型：
--
作者：
Pengo, Vittorio;Ruffatti, Amelia;Iliceto, Sabino
在既往无血栓栓塞事件（TE）史的受试者中偶尔发现持续性抗磷脂（aPL）抗体，这使得是否开始一级血栓预防的两难境地。首次TE在aPL携带者中被认为是罕见的，但先前的研究没有考虑aPL特征，也没有在参考实验室中证实试验阳性。在本研究中，对104例在参考实验室中确认具有高风险aPL特征（阳性狼疮抗凝剂、抗心磷脂和抗β 2-糖蛋白I抗体，三重阳性）的受试者进行了平均4.5年的随访。有25例首次TE（每年5.3%）：10年后的累积发生率为37.1%（95%置信区间[CI]，19.9%-54.3%）。在多变量分析中，男性（风险比= 4.4; 95%CI，1.5-13.1，P = 0.007）和静脉血栓栓塞的风险因素（风险比= 3.3; 95%CI，1.3-8.5，P = 0.01）是TE的独立预测因素。阿司匹林对TE的发生率无显著影响。总之，高风险aPL特征携带者中首次TE的发生率相当高;在男性受试者中更常见，并且存在静脉TE的其他风险因素。这些数据可以帮助决定在这些受试者中开始初级血栓预防。（血。2011; 118（17）：4714-4718）
Persistent antiphospholipid (aPL) antibodies are occasionally found in subjects without prior history of thromboembolic events (TEs), raising the dilemma of whether to initiate or not a primary thromboprophylaxis. A first TE is considered rare in aPL carriers, but previous studies did not consider the aPL profile nor was the test positivity confirmed in a reference laboratory. In this study, 104 subjects with high-risk aPL profile (positive lupus anticoagulant, anticardiolipin, and anti-beta(2)-glycoprotein I antibodies, triple positivity) confirmed in a reference laboratory, were followed up for a mean of 4.5 years. There were 25 first TEs (5.3% per year): the cumulative incidence after 10 years was 37.1% (95% confidence interval [CI], 19.9%-54.3%). On multivariate analysis, male sex (hazard ratio = 4.4; 95% CI, 1.5-13.1, P = .007) and risk factors for venous thromboembolism (hazard ratio = 3.3; 95% CI, 1.3-8.5, P = .01) were independent predictors for TEs. As-pirin did not significantly affect the incidence of TE. In conclusion, the occurrence of a first TE in carriers of high-risk aPL profile is considerable; it is more frequent among male subjects and in the presence of additional risk factors for venous TE. These data can help in the decision to initiate primary thromboprophylaxis in these subjects. (Blood. 2011; 118(17): 4714-4718)