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Antiphospholipid Antibodies and Recurrent Thrombosis after a First Unprovoked Venous Thromboembolism

Clive Kearon, Sameer Parpia, Fredrick A. Spencer, Trevor Baglin, Scott M. Stevens, Kenneth A. Bauer, Steven R. Lentz, Craig M. Kessler, James D. Douketis, Stephan Moll, Scott Kaatz, Sam Schulman, Jean M. Connors, Jeffrey S. Ginsberg, Luciana Spadafora, Vinai Bhagirath, Patricia C. Liaw, Jeffrey I. Weitz and Jim A. Julian

Key points

  • The same type of APA on two occasions, or more than one type of APA on the same or different occasions, are associated with recurrent VTE.

  • APA and D-dimer levels appear to be independently associated with recurrence after a first unprovoked VTE.

Abstract

It is uncertain whether antiphospholipid antibodies (APA) increase the risk of recurrence after a first unprovoked venous thromboembolism (VTE). We tested for anticardiolipin antibodies, anti-β2 glycoprotein I antibodies and lupus anticoagulant on two occasions about six months apart in 307 patients with a first unprovoked VTE who were part of a prospective cohort study. We then determined if APA were associated with recurrent thrombosis in the 290 patients who stopped anticoagulant therapy in response to negative D-dimer results.Compared with those without an APA, the hazard ratios for recurrent VTE were 1.8 (95% confidence interval 0.9 to 3.7; p=0.09) in the 25.9% of patients with an APA on one or more occasion, 2.7 (95%CI 1.1 to 6.7; p=0.03) in the 9.0% of patients with the same APA on two occasions, and 4.5 (95%CI 1.5 to 13.0; p=0.006) in the 3.8% of patients with two or three different APA types on either the same or different occasions. There was no association between having an APA and D-dimer levels. We conclude that having the same type of APA on two occasions, or having more than one type of APA on the same or different occasions, is associated with recurrent thrombosis in patients with a first unprovoked VTE who stop anticoagulant therapy in response to negative D-dimer tests. APA and D-dimer levels appear to be independent predictors of recurrence in patients with unprovoked VTE.

  • Submitted September 8, 2017.
  • Accepted February 18, 2018.