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Thromb Haemost 2004; 92(06): 1312-1319
DOI: 10.1160/TH04-03-0138
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

Antiphospholipid antibodies and thrombosis: association with acquired activated protein C resistance in venous thrombosis and with hyperhomocysteinemia in arterial thrombosis

Jeannine Kassis
1   Department of Hematology, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Quebec, Canada
,
Carolyn Neville
2   Division of Clinical Epidemiology, The Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
,
Joyce Rauch
3   Division of Rheumatology, The Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
,
Lambert Busque
1   Department of Hematology, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Quebec, Canada
,
Erika R. Chang
4   Division of Outcomes and Population Health, University Health Network, University of Toronto, Toronto, Ontario, Canada
,
Lawrence Joseph
2   Division of Clinical Epidemiology, The Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
5   Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
,
Martine Le Comte
2   Division of Clinical Epidemiology, The Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
,
Rebecca Subang
3   Division of Rheumatology, The Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
,
Paul R. Fortin
4   Division of Outcomes and Population Health, University Health Network, University of Toronto, Toronto, Ontario, Canada
6   Division of Rheumatology, University Health Network, University of Toronto, Toronto, Ontario, Canada
› Author AffiliationsFinancial support: Supported by operating grants from The Arthritis Society (#97/0007 [PRF]) and operating grants from the CIHR (#89548 [PRF]; #MT-42391 [JR]). Dr. Fortin is a Scientist from The Arthritis Society/Institute of Musculoskeletal Health and Arthritis and the Director of Clinical Research, Arthritis Centre of Excellence, Division of Rheumatology, University Health Network, and an Associate Professor of Medicine, University of Toronto
Further Information

Publication History

Received 03 March 2004

Accepted after resubmission 09 September 2004

Publication Date:
02 December 2017 (online)

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Summary

Although antiphospholipid antibodies (aPL) are associated with thrombosis, it is not known who with aPL is at higher risk for thrombosis. It was the aim of this cross-sectional study to investigate how thrombophilic factors contribute to venous or arterial thrombosis in aPL-positive individuals. In outpatient test centres at two tertiary care hospitals, two hundred and eight (208) persons requiring aPL testing were matched by age, gender and centre to 208 persons requiring a complete blood count. Persons were classified as aPL-positive (having anticardiolipin, lupus anticoagulant and/or anti-β2-glycoprotein I antibodies) or aPL-negative. Several thrombophilic factors were studied using logistic regression modelling. Results showed that the aPL-positive group had three-fold more events (37%) than the aPL-negative group (12%). In unadjusted analyses, clinically important associations were observed between factor V Leiden and venous thrombosis, hyperhomocysteinemia and arterial thrombosis, and activated protein C resistance (APCR) and venous thrombosis (OR, 95% CI = 4.00, 1.35-11.91; 4.79, 2.03-11.33; and 2.03, 1.03-3.97, respectively). After adjusting for recruitment group, persons with both APCR and aPL had a three-fold greater risk (OR, 95% CI = 3.31, 1.30-8.41) for venous thrombosis than those with neither APCR nor aPL. Similarly, after adjusting for hypertension, family history of cardiovascular disease, gender and recruitment group, persons with both hyperhomocysteinemia and aPL had a five-fold increased risk (OR, 95% CI = 4.90, 1.37-17.37) for arterial thrombosis compared to those with neither risk factor. In conclusion, APCR phenotype and hyperhomocysteinemia are associated with a higher risk of venous and arterial thrombosis, respectively, in the presence of aPL.

Keywords

Antiphospholipid antibodies - antiphospholipid syndrome - thrombosis - activated protein C resistance - hyperhomocysteinemia
 

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