Departments of Clinical Cardiology, University Hospital, Padova, Italy.
Blood. 2011 Oct 27;118(17):4714-8. doi: 10.1182/blood-2011-03-340232. Epub 2011 Jul 15.
Persistent antiphospholipid (aPL) antibodies are occasionally found in subjects without prior history of thromboembolic events (TEs), raising the dilemma of whether to initiate or not a primary thromboprophylaxis. A first TE is considered rare in aPL carriers, but previous studies did not consider the aPL profile nor was the test positivity confirmed in a reference laboratory. In this study, 104 subjects with high-risk aPL profile (positive lupus anticoagulant, anticardiolipin, and anti-β(2)-glycoprotein I antibodies, triple positivity) confirmed in a reference laboratory, were followed up for a mean of 4.5 years. There were 25 first TEs (5.3% per year): the cumulative incidence after 10 years was 37.1% (95% confidence interval [CI], 19.9%-54.3%). On multivariate analysis, male sex (hazard ratio = 4.4; 95% CI, 1.5-13.1, P = .007) and risk factors for venous thromboembolism (hazard ratio = 3.3; 95% CI, 1.3-8.5, P = .01) were independent predictors for TEs. Aspirin did not significantly affect the incidence of TE. In conclusion, the occurrence of a first TE in carriers of high-risk aPL profile is considerable; it is more frequent among male subjects and in the presence of additional risk factors for venous TE. These data can help in the decision to initiate primary thromboprophylaxis in these subjects.
持续存在的抗磷脂（aPL）抗体偶尔在没有先前血栓栓塞事件（TE）病史的患者中发现，这引发了是否开始进行原发性血栓预防的困境。首次 TE 在 aPL 携带者中被认为很少见，但以前的研究没有考虑 aPL 谱，也没有在参考实验室中确认检测的阳性。在这项研究中，104 名在参考实验室中被证实存在高风险 aPL 谱（阳性狼疮抗凝物、抗心磷脂和抗β（2）-糖蛋白 I 抗体，三重阳性）的患者，平均随访 4.5 年。有 25 例首次 TE（每年 5.3%）：10 年后的累积发生率为 37.1%（95%置信区间 [CI]，19.9%-54.3%）。多变量分析显示，男性（危险比=4.4；95%CI，1.5-13.1，P=0.007）和静脉血栓栓塞的危险因素（危险比=3.3；95%CI，1.3-8.5，P=0.01）是 TE 的独立预测因素。阿司匹林对 TE 的发生率没有显著影响。总之，高风险 aPL 谱携带者发生首次 TE 的情况相当多；在男性患者和存在静脉 TE 的其他危险因素时更为常见。这些数据有助于决定是否对这些患者进行原发性血栓预防。
