Published Online
on June 9, 2005

A more recent version of this article appeared on July 1, 2005

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Submitted on March 25, 2005
Revised on April 21, 2005
Accepted on April 26, 2005

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; and 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.

^* To whom correspondence should be addressed. 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 • thrombosis • echocardiography

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