THU0575 HYPERCOAGULABILITY AS A CAUSE OF THROMBOSIS IN BEHÇET’S SYNDROME: A SYSTEMATIC REVIEW AND META ANALYSIS
Authors: Gul Guzelant Ozkose, Berna Yurttas, Sinem Nihal Esatoglu, Vedat Hamuryudan, Hasan Yazici, Gulen Hatemi
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> While thrombosis in Behçet's Syndrome (BS) is considered to be mainly caused by inflammation in the vessel wall, several prothrombotic factors have been studied with inconsistent results. <h3>Objectives</h3> We aimed to perform a systematic review of clinical studies investigating the thrombophilic factors in BS. <h3>Methods</h3> The online database of PubMed was searched with the keyword "Behcet*" in four languages (English, German, French and Turkish) from inception up to May 2018. Titles and/or abstracts of all studies were screened independently by two reviewers (GG and BY) for studies reporting on thrombosis, fibrinolysis, endothelial factors and comparing BS patients with and without thrombosis. Conflicts were solved by a third reviewer (GH). The pooled odds ratios (OR) with 95%CI were calculated for binary outcomes and standardized mean differences (MD) were calculated for continuous outcomes by using RevMan 5.3. <h3>Results</h3> Of 9937 articles, 9373 were excluded due to repetition and inappropriate study design after reviewing titles and abstracts. Full text review of the remaining 564 articles yielded 86 papers meeting our predetermined inclusion criteria. Several factors such as protein C, protein S, active protein C resistance, anti-thrombin III, plasminogen, plasminogen activator inhibitor, fibrinogen, factor 7, factor 12, thrombin activatable fibrinolysis inhibitor, anticardiolipin antibodies, antiß2 Glycoprotein1 antibodies and methylenetetrahydrofolate reductase gene C677T mutation were not different in BS patients with thrombosis compared to those without thrombosis. On the other hand, vascular endothelial growth factor levels, P-selectin glycoprotein ligand-1, platelet-activating factor seemed to be more frequent in BS patients with thrombosis in the few studies reporting on these, including a small number of patients. Among the 11 parameters with controversial results across studies, meta-analysis showed significantly higher homocysteine levels, higher factor 8 levels, more frequent Factor V Leiden mutations and higher von Willebrand factor levels in BS patients with thrombosis, whereas the pooled difference was not significant for mean platelet volume, tissue plasminogen activator, prothrombin gene mutations, lupus anticoagulant, P-selectin level, erythrocyte aggregation and thrombomodulin level (Table). <h3>Conclusion</h3> Among the several prothrombotic factors that were studied in BS patients, factor V Leiden mutation, high homocysteine levels, factor 8 levels and von Willebrand factor levels may be associated with thrombosis in BS. Studies investigating these factors together in a large number of patients together with appropriate controls are needed to confirm these results. MD: mean difference, OR: odds ratio, tPA: tissue plasminogen activator <h3>Disclosure of Interests:&nbsp;</h3> Gul Guzelant Ozkose: None declared, Berna Yurttas: None declared, Sinem Nihal Esatoglu: None declared, Vedat Hamuryudan Consultant for: Abbvie, Amgen, BMS, Jansen, MSD, Pfizer, UCB, Speakers bureau: Abbvie, Amgen, BMS, Jansen, MSD, Pfizer, UCB, Hasan Yazici: None declared, Gulen Hatemi Consultant for: Abbvie, Amgen, BMS, Janssen, MSD, Pfizer, UCB, Speakers bureau: Abbvie, Amgen, BMS, Jansen, MSD, Pfizer, UCB,