SAT0203 SINGLE LAC POSITIVITY VERSUS DOUBLE AND TRIPLE POSITIVITY FOR THROMBOSIS IN SLE
Authors: S. Demir, J. Li, L. Magder, M. A. Petri
Journal: Annals of the Rheumatic Diseases (2020)

Background: The antiphospholipid syndrome (APS) is defined by the development of venous and/or arterial thromboses, and pregnancy morbidity, in the presence of antiphospholipid antibodies (aPL); lupus anticoagulant, moderate-to-high titer anticardiolipin (aCL) and anti-β2-glycoprotein (aB2GPI). It has been suggested that the incidence of thromboembolic events were significantly higher in the triple positive subjects, and the rate of pregnancy loss was also significantly much higher in double positive subjects (1). On the other hand several studies showed that LAC is more highly associated with thrombosis risk (2). Objectives: We aimed to investigate the risk of thrombosis in Systemic Lupus Erythematosus (SLE) patients with single LAC positivity versus double and triple positivity in Hopkins Lupus Cohort. Methods: The Hopkins Lupus Cohort is a prospective longitudinal cohort of SLE patients ongoing since 1987. This analysis was based on cohort experience from 2003 through October 2019. Anticardiolipin and anti-Beta2 glycoprotein were defined as positive when the antibody titer exceeded 20 units. The lupus anticoagulant was determined by dilute Russell’s viper venom time (dRVVT) and confirmatory mixing studies, if prolonged. It is defined as positive if a patient had a dRVVT of 45 or more second and a positive confirm ratio of more than 1.4. For each aPL, we defined the patient as positive at a given month of follow up if they ever had a positivity in previous measures. The relationships between thrombosis and aPL were adjusted for number of prior aPL assessment. Results: There were 805 patients with a complete profile of 7 antiphospholipid antibodies, with a total of 73417 person months (6118 person years) of follow up. For any thrombosis when compared to patients with LAC positivity only, double positivity with any isotypes [1.15(0.50, 2.66) p=0.7484] and triple positivity with any isotypes [1.68(0.74, 3.80), p=0.2145] showed a higher point estimates but statistically not significant (Table 1). Table 1. Single, double and triple positive patterns and the risk of any thrombosis. Pattern Number of events Person-years Rate per 1000 person-years adjusted RR (95% CI) p-value LAC positivity only 10 633 15.8 1.00 (Ref) Never any aPL 33 2581 12,8 0.73(0.36, 1.47) 0.3819 any aCL positivity only 6 793 7,6 0.43(0.16, 1.18) 0.1028 any aB2GPI positivity only 7 517 13,5 0.78(0.30,2.05) 0.6195 any aCL and aB2GPI positivity only 5 404 12,4 0.71(0.24,2.04) 0.5211 LAC and ACL positivity 7 406 17,3 1.15(0.50,2.66) 0.7484 LAC and aB2GPI positivity 12 490 24,5 Triple positivity 0 147 0,0 1.68(0.74,3.80) 0.2145 Conclusion: We found that triple or double positive aPL profiles are not superior to single LAC positivity in their association with any thrombosis in SLE patients. References: [1]Pengo V, Ruffatti A, Del Ross T, Tonello M, Cuffaro S, Hoxha A, Banzato A,Bison E, Denas G, Bracco A, Padayattil Jose S. Confirmation of initial antiphospholipid antibody positivity depends on the antiphospholipid antibody profile. J Thromb Haemost. 2013 Aug;11(8):1527-31. [2]Galli M, Luciani D, Bertolini G, Barbui T. Lupus anticoagulants are stronger risk factors for thrombosis than anticardiolipin antibodies in the antiphospholipid syndrome: a systematic review of the literature. Blood. 2003; 101(5):1827-32. Disclosure of Interests: Selcan Demir: None declared, Jessica Li: None declared, Laurence Magder: None declared, Michelle A Petri Grant/research support from: GSK, Eli Lilly and Company, Consultant of: Eli Lilly and Company