Determinantes clínicos y biológicos en la estratificación del riesgo de recurrencias trombóticas arteriales y venosas en una cohorte de pacientes con síndrome antifosfolípidos primarioinfluencia del perfil de anticuerpos y los factores de riesgo cardiovascular. Validación de la escala gapss

Abstract

Keywords: antiphospholipid, recurrence, GAPSS, risk of thrombosis, cardiovascular risk factors. Objectives: The antiphospholipid syndrome (APS) is a thrombophilia characterized by a high rate of thrombotic recurrence. Risk factors and prediction scales (GAPSS and aGAPSS) of a first thrombosis have been identified and validated in aPL carriers. However, few studies have researched about risk factors of recurrence in patients with APS after a first thrombotic event. The objective of this study is the identification of these risk factors and the validation of these scales in patients with primary APS that allow the risk stratification of a second thrombotic event. Methods: Observational retrospective and prospective study in a cohort of patients with primary APS and at least one thrombotic manifestation. We analyzed demographic, clinical variables, cardiovascular risk factors, the aPL profile and the GAPSS and GAPSS scales adjusted by univariate and multivariate Cox regression. Results: 84 patients with primary APS (mean age 44.0 ± 13.7 years, men 57.1%) were followed (median 128 months) from their first thrombosis (venous 70.2% and arterial 29.8%). In the multivariate analisis the absence of maintenance anticoagulant [HR 4.255 (1.721-10.526 IC 95%); p=0.002], aCL IgM [HR 2.506 (1.027-6.118 IC 95%); p=0.044] and LA ratio >1.6 [HR 3.408 (1.319-8.805 IC 95%); p=0.011] were identified as risk factors of thrombotic recurrence (arterial and/or venous). For venous recurrence were identified the absence of maintenance anticoagulant [HR 7.806 (2.209-27.585 IC 95%); p=0.001], LA ratio >1.6 [HR 4.419 (1.412-13.830 IC 95%); p=0.011] and active tobacco smoking [HR 3.070 (1.162-8.111 IC 95%); p=0.024]. For arterial recurrence were identified IgM anticardiolipin [HR 16.685 (3.772-73.814 IC 95%); p<0001], hypertriglyceridemia [HR 6.862 (1.551-30.357 IC 95%); p=0.011], age?50 years at the first thrombosis [HR 5.052 (1.012-25.219 IC 95%); p=0.048], GAPSS?9 [HR 5.019 (1.199-21.010 IC 95%); p=0.008], and aGAPSS?8 [HR 6.032 (1.209-30.101 IC 95%); p=0.028]. Conclusion: aCL IgM, hypertriglyceridemia, age?50 years at the first thrombosis, GAPSS?9 and aGAPSS?8 were independent risk factors for arterial thrombotic recurrence. The absence of indefinite anticoagulation, LA ratio >1.6 and active tobacco smoking were for venous thrombotic recurrence. The stratification of the risk of venous and arterial recurrence in primary APS patients, separately, could help to optimize secondary prophylaxis and avoid recurrences in these patients.