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(Stroke. 2005;36:1490.)
© 2005 American Heart Association, Inc.

Original Contributions

Thrombotic Risk Factors In Primary Antiphospholipid Syndrome

A 5-Year Prospective Study

Maurizio Turiel, MD; Piercarlo Sarzi-Puttini, MD; Rossana Peretti, MD; Edoardo Rossi, MD; Fabiola Atzeni, MD; Wendy Parsons, BSc, Mph Andrea Doria, MD

From the Department of Cardiology (M.T.. R.P.) Istituto Ortopedico Galeazzi, University of Milan, Italy; the Rheumatology Unit (P.S.-P., E.R., F.A.), Blood Transfusion Center, L. Sacco Hospital, University of Milan, Italy; the Research & Development Directorate (W.P.), Leeds Teaching Hospitals NHS Trust, UK; and the Division of Rheumatology (A.D.), University of Padova, Italy.

Correspondence to Maurizio Turiel, MD, Department of Cardiology, Istituto Ortopedico Galeazzi, University of Milan, Via Galeazzi 4, 20161 Milan, Italy. E-mail maurizio.turiel{at}unimi.it

Background and Purpose— Because thromboembolic events are frequently observed in primary antiphospholipid syndrome (PAPS), we assessed the risk factors for new thrombotic episodes.

Methods— Fifty-six PAPS patients (mean age, 37±10 years) were prospectively studied for 5 years. The preliminary Sapporo classification criteria for antiphospholipid syndrome (APS; a medium–high anticardiolipin antibody [aCL] titer and/or a positive lupus anticoagulant [LA] test in the presence of vascular thrombosis and/or pregnancy morbidity) were used to confirm the diagnosis. Thrombotic episodes or pregnancy losses before a diagnosis of PAPS were considered events, and any new disease manifestation other than thrombocytopenia was considered a recurrent event. Only patients with objectively verified thrombotic events were included in the study.

Results— Twenty-one new thrombotic events were observed in 15 subjects (26.8%), including 3 (5.4%) who died during the follow-up. The patients with IgG aCL levels of >40 IgG phospholipid unit (GPL-U) showed a higher incidence of new thrombotic events (43.3%) than those with levels of 40 GPL-U (7.7%). Univariate analysis identified a history of recurrent clinical events (P=0.004), a highly positive aCL titer (P=0.007), and the presence of cardiac abnormalities (P=0.036) as significant risk factors for new thrombotic events. A multivariate regression model confirmed that an IgG aCL titer of >40 GPL-U was an independent risk factor for thrombosis (odds ratio, 9.17; 95% confidence interval, 1.83 to 46.05).

Conclusions— A high IgG aCL titer is the strongest predictor of new thrombotic events in PAPS patients.

Key Words: antiphospholipid syndrome • echocardiography • thrombosis

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