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The risk of ischaemic stroke in primary antiphospholipid syndrome patients: a prospective study
M Radin1, K Schreiber2,3, I Cecchi1
1Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, and SCDU Nephrology and Dialysis, University of Turin and S. Giovanni Bosco Hospital, Turin, Italy.
Insights
Identifying predictive factors for ischemic stroke in primary antiphospholipid syndrome (APS) patients is crucial. This study found hypercholesterolemia, anti-β2 glycoprotein-I antibodies, and higher aGAPSS scores predict stroke risk in PAPS patients.
Area of Science:
- Neurology
- Rheumatology
- Immunology
Background:
- Antiphospholipid syndrome (APS) commonly presents with neurological issues, primarily ischemic stroke.
- Risk stratification for thrombotic events in APS patients remains a significant clinical challenge.
- Primary APS (PAPS) patients presenting with acute stroke symptoms require identification of predictive factors for recurrence.
Purpose of the Study:
- To identify predictive factors for ischemic stroke in a cohort of primary APS patients.
- To assess risk factors in PAPS patients experiencing new-onset symptoms suggestive of acute stroke.
Main Methods:
- Prospective, multicenter study involving 36 PAPS patients with acute stroke symptoms.
- 12-month follow-up period for all participants.
- Brain MRI confirmed stroke in 28% of patients; data analyzed for predictive factors.
Main Results:
- Confirmed stroke in 10/36 PAPS patients, with 60% under 50 years old.
- Higher prevalence of hypercholesterolemia (P < 0.05) in patients with confirmed stroke.
- Elevated anti-β2 glycoprotein-I (β2GPI) antibodies (IgG/IgM) and higher adjusted global APS score (aGAPSS) were significantly associated with stroke (P < 0.05).
Conclusions:
- PAPS patients, including younger individuals, face a high risk of recurrent thrombosis despite anticoagulation.
- Comprehensive risk assessment is essential for identifying PAPS patients prone to recurrent thrombotic events.
- Specific biomarkers like anti-β2GPI antibodies and aGAPSS may aid in risk stratification.
Background And Purpose:
The most common neurological manifestation of antiphospholipid syndrome (APS) is ischaemic stroke. Identifying patients with APS at high risk for developing any thrombotic event remains a major challenge. In this study, the aim was to identify predictive factors of ischaemic stroke in a cohort of primary APS (PAPS) patients who presented with new onset symptoms suggestive of acute stroke.
Methods:
This prospective multicentre study included 36 consecutive PAPS patients who presented with new onset symptoms suggestive of an acute stroke. Patients were prospectively followed up for 12 months.
Results:
In 10 (28%) out of 36 PAPS patients [mean age 41 years (SD 13.4), 70% female], the suspicion of an acute stroke was confirmed by brain magnetic resonance imaging. Sixty per cent of these patients were <50 years old. Eight of the 10 patients had a history of previous venous thrombosis and were receiving vitamin K antagonist (VKA), with international normalized ratio target 2-3; one patient had a history of a previous arterial event receiving treatment with VKA target international normalized ratio 2-3 plus low dose aspirin; and one patient had a history of previous pregnancy morbidity receiving only low dose aspirin. Time in the therapeutic range for patients receiving VKA was 77.7% (SD 6.6%). Hypercholesterolaemia was significantly higher in patients with confirmed stroke compared to those without (P < 0.05). Similarly, a significantly higher rate of anti-β2 glycoprotein-I (β2GPI) antibodies (immunoglobulin G/immunoglobulin M; P < 0.05) and higher adjusted global APS score (aGAPSS) values were found in patients with a confirmed stroke [mean aGAPSS 8.9 (SD 4.7) vs. mean aGAPSS 6.4 (SD 2.5); P < 0.05].
Conclusions:
Patients with PAPS, including young patients, have a high risk of recurrent thrombosis despite anticoagulation treatment. A careful risk assessment is mandatory to identify patients at risk for recurrence.
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