Elsevier

Thrombosis Research

Volume 96, Issue 4, 15 November 1999, Pages 269-274
Thrombosis Research

Regular article
Anti-β2-Glycoprotein I Antibodies in Patients with Acute Venous Thromboembolism: Prevalence and Association with Recurrent Thromboembolism

https://doi.org/10.1016/S0049-3848(99)00105-XGet rights and content

Abstract

To establish the prevalence of antibodies against β2-glycoprotein I (β2GPI) in unselected patients with venous thromboembolism, as well as the association with antiphospholipid antibodies (aPL) and a history of previous thromboembolism, we investigated the presence of these antibodies in 227 consecutive patients with acute deep vein thrombosis or pulmonary embolism, of whom 63 were carriers of aPL with or without lupus anticoagulant (LA), and seven were carriers of LA alone. The presence of antibodies against β2GPI was demonstrated in 19 patients [8.4%; 95% confidence interval (CI), 4.5–11.3%]. All of them belonged to the group of 63 patients with aPL (30.2%). A history of a previous thromboembolism was identified in 11 of the 19 patients with anti-β2GPI antibodies (57.9%) and in 45 of the 208 patients without these antibodies [21.6%; odds ratio (OR)=4.98; 95% CI, 1.89–13.1; p<0.0005]. In the subgroup of patients with aPL and/or LA, the rate of recurrent thromboembolism among patients with anti-β2GPI antibodies (11 of 19, 57.9%) was significantly higher than that observed in patients without these antibodies (15 of 51, 29.4%; OR=3.3; 95% CI, 1.1–9.83; p=0.28). We conclude that in patients with acute venous thromboembolism the prevalence of antibodies against β2GPI is unexpectedly high. The presence of these antibodies seems to identify a subgroup of patients with antiphospholipid antibodies who have a peculiarly high risk of thrombotic recurrences. Further prospective studies are indicated to better define the role of anti-β2GPI antibodies in the development of recurrent thromboembolism.

Section snippets

Patients

All consecutive patients who were referred to the Thrombosis Unit of Padua University between January 1994 and December 1998 for an episode of acute venous thromboembolism were eligible for the investigation, provided that the disease was objectively confirmed according to standard methods 11, 12, 13. Patients with systemic lupus erythematosus (SLE) or lupus-like disease were excluded, as were patients with cancer, pregnant women and carriers of antithrombin, protein C or S defect, and

Results

Out of 288 eligible patients, 61 were excluded because of hereditary thrombophilia (36), cancer (20), systemic lupus erythematosus (3), or pregnancy (2). Therefore, 227 patients were enrolled in the current investigation. Laboratory determinations showed the presence of aPL and/or LA in 70 patients (30.8%): aPL alone in 44 patients, LA alone in 7, and both in the remaining 19. When considering only patients with aPL (44+19) we found a low positivity in 37, moderate positivity in 18, and high

Discussion

The results of our study strongly suggest that the frequency of antibodies directed against β2GPI in unselected patients with acute venous thromboembolism is relatively high, approaching 10% of patients. Furthermore, their presence is identifiable in approximately one third of patients who are carriers of aPL (with or without LA), specifically in those with an aPL titre >15 UPL/mL. Interestingly, in no patients of our cohort with LA in the absence of aPL were anti-β2GPI antibodies detected.

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