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  • Evaluation of different ways to identify persistent positivity of lupus anticoagulant in systemic lupus erythematosus

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Biomarker studies
Original research
Evaluation of different ways to identify persistent positivity of lupus anticoagulant in systemic lupus erythematosus
  1. Michelle A Petri1,
  2. Mertcan Avci2 and
  3. Laurence S Magder3
  1. 1Division of Rheumatology, Johns Hopkins Medicine School of Medicine, Baltimore, Maryland, USA
  2. 2Istanbul University Faculty of Medicine, Istanbul, Turkey
  3. 3School of Medicine, Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore, Maryland, USA
  1. Correspondence to Dr Michelle A Petri; mpetri{at}jhmi.edu

Abstract

Objective Persistent positivity for lupus anticoagulant has been associated with an increased risk of thrombosis among patients with SLE. Persistent positivity is often defined as having two positive assessments separated by more than 90 days. Our objective was to determine whether frequent repeated lupus anticoagulant testing would identify more patients with persistent positivity, and whether the additional patients identified were still at increased risk of thrombosis.

Methods Using a large longitudinal cohort with frequent lupus anticoagulant testing, we compared three different hypothetical clinical strategies for identifying persistent positivity: (1) assessment of lupus anticoagulant twice more than 90 days apart; (2) assessment of lupus anticoagulant annually, with repeat testing if an annual assessment was positive; and (3) assessment of lupus anticoagulant 16 times (approximately quarterly for 4 years). The prevalence of persistent positivity was compared between the approaches and by demographic subgroups. Subgroups based on these definitions were compared with respect to the risk of thrombosis in subsequent follow-up using discrete survival analysis.

Results Among the 785 patients included in our analysis, the prevalence of persistent lupus anticoagulant as defined by the first two patient assessments was 4.3%. Annual assessment resulted in a prevalence of 6.6%, and using all 16 assessments resulted in a prevalence of 10.5%. The prevalence was substantially higher in men than in women, and in Caucasians than in African-Americans (p<0.01 for all comparisons). The rate of thrombosis was significantly elevated among those with persistently positive lupus anticoagulant by any definition (HR ranging from 2.75 to 3.42) relative to those without persistently positive lupus anticoagulant.

Conclusion While there are other risk factors for thrombosis (including other antiphospholipid subtypes), more frequent testing (not limited to twice over 3 months) for lupus anticoagulant would be useful for identifying more patients with SLE at elevated risk for thrombosis.

  • lupus erythematosus
  • systemic
  • antibodies
  • antiphospholipid
  • epidemiology
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/lupus-2020-000406

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    Footnotes

    • Contributors MAP contributed to the conception, study design, collection of all data, interpretation of the results and preparation of the manuscript. MA contributed to the conception, study design, interpretation of the results and preparation of the manuscript. LSM contributed to the conception, study design, analysis of data, interpretation of the results and preparation of the manuscript.

    • Funding The Hopkins Lupus Cohort is funded by NIH R01 AR069572.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The Hopkins Lupus Cohort was reviewed and approved by the Johns Hopkins School of Medicine Institutional Review Board (study number NA_00039294) and conducted according to the research ethics standards of the USA.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request from MAP (mpetri@jhmi.edu).

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.