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Randomized Controlled Trial
. 2015;40(5-6):293-300.
doi: 10.1159/000441362. Epub 2015 Oct 29.

Antiphospholipid Antibodies and Recurrent Thrombotic Events: Persistence and Portfolio

Colum F Amory  1 , Steven R Levine, Robin L Brey, Mulugeta Gebregziabher, Stanley Tuhrim, Barbara C Tilley, Ann-Catherin C Simpson, Ralph L Sacco, Jay P Mohr; APASS-WARSS Collaborators
Collaborators, Affiliations
Randomized Controlled Trial

Antiphospholipid Antibodies and Recurrent Thrombotic Events: Persistence and Portfolio

Colum F Amory et al. Cerebrovasc Dis. 2015.

Abstract

Background: There are very limited prospective data on the significance of persistent antiphospholipid antibodies (aPL) and recurrent thrombo-occlusive events (TOEs). We investigated the prognostic value of (1) 2 newer aPL assays, (2) an aPL portfolio and (3) persistent aPL positivity following stroke.

Methods: A total of 1,770 subjects from the APASS-WARSS study underwent further aPL testing for antibodies to phosphatidylserine (aPS) and anti-β2-glycoprotein-I (anti-β2GPI) from stored sera. Follow-up aPL status was also tested in a subset of subjects. Primary analysis was based on time to any TOE (ischemic stroke, myocardial infarction, transient ischemic attack, deep vein thrombosis, pulmonary embolism or systemic arterial occlusion)/death at 2 years. Cox proportional hazard analyses assessed whether aPL independently related to outcome.

Results: Persistent anti-β2GPI decreased the time to TOE/death after adjustment for potential confounders (hazards ratio (HR) 2.86, 95% CI 1.21-6.76, p = 0.017). When persistent anti-β2GPI was combined with another persistently positive aPL, time to TOE/death was also reduced (HR 3.79, 95% CI 1.18-12.14, p = 0.025). Neither persistent anticardiolipin antibodies nor persistent aPS alone nor a single positive anti-β2GPI nor aPS was associated with decreased time to TOE/death. No single positive aPL, portfolio of baseline aPL or any persistent aPL increased the rate of TOE/death.

Conclusions: Rates of TOE/death were not influenced by aPL results at baseline or follow-up. Persistent anti-β2GPI alone, and with persistent second aPL, was independently associated with decreased time to TOE/death. Persistent aPL, an aPL portfolio and newer aPL in ischemic stroke patients are not helpful in predicting an increased rate of recurrent TOEs.

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Figures

Figure 1
Figure 1. Kaplan-Meier Curve for time to TOE or death with persistently positive β2-GPI assays
Figure 2
Figure 2. Kaplan-Meier curves for time to TOE or death with persistently positive β2-GPI assays and at least one other persistently positive aPL assay
See this image and copyright information in PMC

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