POS0777 ANTIPHOSPHOLIPID RELATED LARGE VESSEL LESIONS: NOT ONLY THROMBOSIS
Authors: H. Jiang, W. Qi, J. Zhao, Y. Zhao
Journal: Annals of the Rheumatic Diseases (2021)

Background: Antiphospholipid syndrome (APS) is demonstrated as recurrent venous/arterial thromboses or obstetric morbidities with persistent antiphospholipid antibodies(aPLs). Recently, several cases reported that non-thrombotic lesions of large vessels may exist in APS, while less report described the characteristics of these patients. Objectives: The study investigated patients with chronic large vessel lesions (stenosis or occlusion) (LVL) in APS, to detect the features of non-thrombotic arterial vasculopathy in APS (VAPS) by comparing with thrombotic APS (TAPS). Methods: This is a single-center study involved the APS database from Peking Union Medical College Hospital (PUMCH) from 2013 to 2020. The study analyzed demography and laboratory index of 18 patients with LVL by comparing with 216 patients with thrombotic APS. Patients with LVL presented no specific vasculitis or in situ thrombosis at the lesion. Results: Radiographic analysis in patients with LVL showed widespread thickening/enhancement of vessel wall or multiple segments stenoses, without intraluminal thrombus or atherosclerosis. In comparing with 216 patients with TAPS, the 18 patients with LVL complicated no other autoimmune diseases, had more cardiovascular risks (72.22% vs. 30.09%, P &lt; 0.01), lower inflammatory index such as erythrocyte sedimentation rate (ESR) (6 vs. 11, p&lt;0.05), increased cerebrovascular symptoms which maybe related to cerebral/carotid vessel occlusions (55.56%vs. 25.93%, p=0.01). Population characteristics, complications and antibody profiles in VAPS are similar to TAPS. Conclusion: Large vessel lesions in APS could present non-thrombotic and non-inflammatory manifestations which is different from TAPS. Table 1. Demographic characteristics TAPS(n=216) VAPS(n=18) P-value Age (years), Mean±SD 39.36±13.69 40.06±13.86 .290 Male, n (%) 88(40.74) 9(50.00) .300 SLE, n (%) 53(24.54) 0 .008 Other autoimmune diseases, n (%) 4(1.85) 0 .724 B.M.I. (kg/m2), Mean±SD 24.10±4.12 23.93±3.31 .469 Cardiovascular risk factors, n (%) 65(30.09) 13(72.22) .001 Non-criteria manifestations, n (%) 109(50.46) 7(38.89) .243 Triple positive antibodies, n (%) 124(57.4) 13(72.22) .165 Double positive antibodies, n (%) 46(21.30) 4(22.22) .563 Single positive antibody, n (%) 45(20.83) 1(5.56) .096 Arterial thrombosis, n(%) 100(46.30) 16(88.89) .000 Stroke 56(25.93) 10(55.56) .010 Venous thrombosis, n(%) 152(70.37) 8(44.44) .025 ESR (mm/h), Median (Quartile) 11(5.00,29.00) 6(2.75,14.00) .035 CRP (mg/L), Median (Quartile) 1.52(0.59,4.44) 1.28(0.26,1.91) .054 Hcy(umol/L), Median (Quartile) 13.45(11.1,17.1) 13.55(10.9,16.38) .406 * SLE : systemic lupus erythematosus; B.M.I : Body Mass Index; Cardiovascular risks positive : patients with at least one positive of smoke, coronary heart disease, hypertension, diabetes, obesity or hyperlipidemia; Non-criteria manifestations : at least one positive of thrombocytopenia, hemolytic anemia, vulve vegetation, nephropathy, livedo reticularis, skin ulcer or non-stroke central nervous system manifestations; ESR : erythrocyte sedimentation rate; CRP : C-reactive protein; Hcy : homocysteine. Disclosure of Interests: None declared