Cardiovascular risk factors are major determinants of thrombotic risk in patients with the lupus anticoagulant.
Cardiovascular risk factors are major determinants of thrombotic risk in patients with the lupus anticoagulant.
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DOI：
10.1186/s12916-017-0807-7
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发表时间：
2017-03-10
期刊：
影响因子：
9.3
通讯作者：
Pabinger I
中科院分区：
文献类型：
--
作者：
Posch F;Gebhart J;Rand JH;Koder S;Quehenberger P;Pengo V;Ay C;Pabinger I
患有狼疮抗凝剂（LA）的患者发生血栓形成事件的风险增加，这反过来又增加了死亡风险。了解LA患者血栓形成风险的决定因素可能为靶向血栓预防铺平道路。在维也纳狼疮抗凝和血栓形成研究（LATS）中，我们系统地评价了LA患者血栓形成事件的危险因素。我们随访了150例患者（平均年龄：41.3岁，女性：n = 122（81.3%），血栓形成或妊娠并发症史：n = 111（74.0%）），这些患者在发生血栓形成、死亡或删失之前多次检测LA呈阳性。主要终点是动脉或静脉血栓形成事件（TE）的复合终点。在中位随访9.5年（范围：12天-13.6年）和1076人-年期间，发生了32起TE（动脉：n = 16，静脉：n = 16;累积10年TE发生率：24.3%）。狼疮敏感性活化部分凝血活酶时间（aPTT-LA）延长（调整的亚分布风险比（SHR）= 2.31，95% CI：1.07- 5.02），糖尿病（调整的SHR = 4.39，95% CI：1.42-13.57），以及主动吸烟（校正的SHR = 2.31，95%CI：1.14-5.02）是动脉和静脉血栓形成风险的独立危险因素。包括狼疮敏感性aPTT延长、吸烟和糖尿病的风险模型使LA患者能够分层为血栓形成低、中和高风险亚组（5年TE风险为9.7%（n = 77）、30.9%（n = 51）和56.8%（n = 22））。LA患者的长期血栓形成风险聚集在除狼疮敏感性aPTT延长外还具有典型心血管风险因素的受试者中，而无这些风险因素的患者代表血栓形成风险较低的大型亚组。本文的在线版本（doi：10.1186/s12916-017-0807-7）包含补充材料，可供授权用户使用。
Patients with the lupus anticoagulant (LA) are at an increased risk of thrombotic events, which in turn increase the risk of death. Understanding the determinants of thrombotic risk in patients with LA may pave the way towards targeted thromboprophylaxis. In the Vienna Lupus Anticoagulant and Thrombosis Study (LATS), we systematically evaluate risk factors for thrombotic events in patients with LA. We followed 150 patients (mean age: 41.3 years, female gender: n = 122 (81.3%), history of thrombosis or pregnancy complications: n = 111 (74.0%)), who tested repeatedly positive for LA until development of thrombosis, death, or censoring. The primary endpoint was a composite of arterial or venous thrombotic events (TEs). During a median follow-up of 9.5 years (range: 12 days–13.6 years) and 1076 person-years, 32 TEs occurred (arterial: n = 16, venous: n = 16; cumulative 10-year TE incidence: 24.3%). A prolonged lupus-sensitive activated partial thromboplastin time (aPTT-LA) (adjusted subdistribution hazard ratio (SHR) = 2.31, 95% CI: 1.07–-5.02), diabetes (adjusted SHR = 4.39, 95% CI: 1.42–13.57), and active smoking (adjusted SHR = 2.31, 95% CI: 1.14–5.02) emerged as independent risk factors of both arterial and venous thrombotic risk. A risk model that includes a prolonged lupus-sensitive aPTT, smoking, and diabetes enabled stratification of LA patients into subgroups with a low, intermediate, and high risk of thrombosis (5-year TE risk of 9.7% (n = 77), 30.9% (n = 51), and 56.8% (n = 22). Long-term thrombotic risk in patients with LA is clustered within subjects harboring typical cardiovascular risk factors in addition to a prolonged lupus-sensitive aPTT, whereas patients with none of these risk factors represent a large subgroup with a low risk of thrombosis. The online version of this article (doi:10.1186/s12916-017-0807-7) contains supplementary material, which is available to authorized users.