Journal
CEREBROVASCULAR DISEASES
Volume 40, Issue 5-6, Pages 293-300Publisher
KARGER
DOI: 10.1159/000441362
Keywords
Antiphospholipid antibodies; Ischemic stroke; Thrombosis; Coagulation; Outcomes; Epidemiology; Recurrent stroke risk
Categories
Funding
- NIH [R01NS30896, K24NS43992, R01NS28371, R01NS52417, T32NS051147, R01HL096944]
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Background: There are very limited prospective data on the significance of persistent antiphospholipid antibodies (aPL) and recurrent thrombo-occlusive events (TOEs). We investigated the prognostic value of (1) 2 newer aPL assays, (2) an aPL portfolio and (3) persistent aPL positivity following stroke. Methods: A total of 1,770 subjects from the APASS-WARSS study underwent further aPL testing for antibodies to phosphatidylserine (aPS) and anti-beta(2)-glycoprotein-I (anti- beta(2) GPI) from stored sera. Follow-up aPL status was also tested in a subset of subjects. Primary analysis was based on time to any TOE (ischemic stroke, myocardial infarction, transient ischemic attack, deep vein thrombosis, pulmonary embolism or systemic arterial occlusion)/death at 2 years. Cox proportional hazard analyses assessed whether aPL independently related to outcome. Results: Persistent anti-beta(2) GPI decreased the time to TOE/death after adjustment for potential confounders (hazards ratio (HR) 2.86, 95% CI 1.21-6.76, p = 0.017). When persistent anti-beta(2) GPI was combined with another persistently positive aPL, time to TOE/death was also reduced (HR 3.79, 95% CI 1.18-12.14, p = 0.025). Neither persistent anticardiolipin antibodies nor persistent aPS alone nor a single positive anti-beta(2) GPI nor aPS was associated with decreased time to TOE/ death. No single positive aPL, portfolio of baseline aPL or any persistent aPL increased
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