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Thrombotic events linked with increased mortality in patients with lupus anticoagulant
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For individuals positive for lupus anticoagulant, the occurrence of a thrombotic event is linked with higher mortality, according to research published in Blood.
These findings, from patients involved in the Lupus Anticoagulant and Thrombosis Study (LATS) followed for an average of 8 years, suggest preventing thromboembolic events in lupus anticoagulant (LA) could improve survival.
“In our cohort of patients with persistent LA followed prospectively within the Vienna LATS, we could demonstrate that the occurrence of thromboembolic events in these patients is associated with an approximately six-fold increased risk of death,” the researchers wrote.
Johanna Gebhart, of the clinical division of hematology and hemostaseology, Medical University of Vienna, Austria, with Ingrid Pabinger, MD, and colleagues from the institution studied 151 LA-positive individuals (82% female) to investigate mortality rates and influencing factors.
The researchers collected data on arterial and venous thromboembolic events (previous and new onset), related diseases and medication using a standardized questionnaire and chart review; all events were symptomatic and diagnosed with standardized methods.
Follow-up visits took place in an outpatient setting every 6 months during the first 5 years, then at yearly intervals. Blood samples were drawn at inclusion and every visit, and LA and anticardiolipin (aCL) and anti–beta2-glycoprotein I (anti–beta2-GPI) antibodies were determined.
The investigators obtained data on mortality among the general Austrian population from the country’s death registry for comparison.
Thirty patients (20%) developed 32 thromboembolic events (15 arterial and 17 venous events), and 20 patients (13%) died. Based on univariable analysis, new onset of thrombosis (HR = 8.76; 95% CI, 3.46-22.16) was associated with adverse survival. Thrombosis continued to be a strong prognostic factor for adverse survival after adjustments for age and hypertension (HR=5.95; 95% CI, 2.43-14.95).
Related autoimmune diseases, anticoagulant treatment at baseline or positivity for aCL or anti–beta2-GPI antibodies were not associated with increased death.
In the relative survival analysis, with individuals matched for age, sex, and study-inclusion year, LA-positive individuals demonstrated worse survival compared with the Austrian reference population. Cumulative relative survival was 95% (95% CI, 88.5-98.8) after 5 years and 87.7% (95% CI, 76.3-95.6) after 10 years.
“The association between occurrence of thrombosis and worse survival was independent of age, hypertension, sex, a positive history of thrombosis, anticoagulation at inclusion, concomitant autoimmune disease and positivity for antibodies against aCL and [beta]2-GPI,” the researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.
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