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- Title
Reduced plasma fibrin clot permeability is associated with recurrent thromboembolic events in patients with antiphospholipid syndrome.
- Authors
Celińska-Löwenhoff, Magdalena; Zabczyk, Michal; Iwaniec, Teresa; Plens, Krzysztof; Musiał, Jacek; Undas, Anetta
- Abstract
Objectives APS is associated with arterial and venous thrombosis. The unfavourable fibrin clot phenotype, including formation of dense and poorly lysable clots, has been reported in thrombotic APS. We investigated whether abnormal plasma clot properties are predictive of recurrent thromboembolism in APS. Methods We followed 126 consecutive patients with thrombotic APS and 105 control subjects, without APS, matched for thrombotic events. Plasma fibrin clot permeability (K s), turbidity measurements and clot lysis time were evaluated ⩾5 months after a thrombotic event. The primary composite end point was symptomatic recurrent venous thromboembolism, ischaemic stroke and/or myocardial infarction. Results During follow-up (median, 62 months; range 46–74 months; 1183.2 patient-years), the primary outcome was observed in 33 (26.2%) APS patients and 16 (15.2%) controls, including 25 (19.8%) and 14 (13.3%) subjects with recurrent venous thromboembolism, respectively. Reduced K s and prolonged clot lysis time predicted recurrent thromboembolic events in APS patients [per 1 × 10−9 cm2: hazard ratio (HR) = 0.37; 95% CI: 0.24, 0.56; and per 10 min: HR = 1.20; 95% CI: 1.01, 1.40, respectively] and in controls (per 1×10−9 cm2: HR = 0.23; 95% CI: 0.11, 0.42; and per 10 min: HR = 1.51; 95% CI: 1.08, 2.16, respectively). A multivariate analysis showed that positive IgG and IgM anti-β2 glycoprotein I antibodies, withdrawal of anticoagulation, lower platelet count and reduced K s predicted thromboembolic events in APS patients. Conclusion Formation of denser fibrin networks could be a novel risk factor for recurrent thromboembolism in APS, which highlights the importance of fibrin phenotype in thrombotic disorders.
- Subjects
ANTICOAGULANTS; THROMBOEMBOLISM risk factors; ANTIPHOSPHOLIPID syndrome; CONFIDENCE intervals; FIBRIN; IMMUNOGLOBULINS; MULTIVARIATE analysis; MYOCARDIAL infarction; PERMEABILITY; THROMBOEMBOLISM; THROMBOSIS; VEINS; PHENOTYPES; DISEASE relapse; TERMINATION of treatment; TREATMENT effectiveness; PLATELET count
- Publication
Rheumatology, 2018, Vol 57, Issue 8, p1340
- ISSN
1462-0324
- Publication type
Article
- DOI
10.1093/rheumatology/key089