VPB0419 - Renal function at enrollment but not change over time is associated with arterial thrombotic events in patients positive for lupus anticoagulant

Sunday, July 10, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Co-Author(s)

MC

Meaghan Colling, MD

Clinical Research Fellow
Medical University of Vienna
Vienna, Wien, Austria
FP

Florian Posch

Hematology Fellow
Medical University of Graz
Graz, Steiermark, Austria
Cihan Ay, MD

Professor, Head of the Thrombosis and Haemostasis Research Group
Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
Vienna, Wien, Austria
SK

Silvia Koder

Technician
Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Austria
Vienna, Vorarlberg, Austria
Ingrid Pabinger, MD

Co-Head of the Thrombosis and Haemostasis Research Group
Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
Vienna, Wien, Austria

Presenting Author(s)

Johanna Gebhart, MD, PhD

Ap. Prof. Dr. PhD
Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
Vienna, Wien, Austria

Background: Patients with lupus anticoagulant (LA) are at risk for arterial and venous thromboembolic events (ATE, VTE). Patients who experience ATE may constitute a distinct subgroup and benefit from specialized therapeutic approaches. Further work is needed to better characterize this subgroup.

Aims: Identify patient characteristics and laboratory parameters associated with the development of ATE in LA positive patients.

Methods: Patients with at least 2 positive LA tests were monitored for ATE within the prospective Vienna Lupus Anticoagulant and Thrombosis Study (EC. 068/2001 and 1268/2014)

Results: This analysis included 187 patients, 156 female (83%) with a median age of 40.5 years (IQR 31.0-55.0) and median follow-up of 11.4 years. Twenty-seven prospective ATEs occurred and the 10-year prospective ATE incidence was 13.9% [95%CI: 8.3-19.6]. Prospective ATE risk was associated with age, body mass index (BMI), history of ATE, active smoking, diabetes, VKA use at baseline, aCL IgM positivity, aβ2GPI IgM positivity, mean platelet volume, creatinine, and estimate glomerular filtration rate (CKD-EPI) (Table 1). After adjusting for traditional arterial thrombotic risk factors (age, sex, BMI, active smoking, diabetes), history of ATE, prior history of both ATE and VTE, creatinine, and eGFR remained independently associated with prospective risk of ATE (Table 1). There was a significant difference in 10-year incidence of ATE when patients were stratified by baseline eGFR (Gray’s test, p=0.019, Figure 1). However, in the patients who had a follow-up creatinine measured within two years of enrollment (n= 88), change in eGFR (neither any change nor decrease) did not associate with prospective ATE risk (p= 0.17).

Conclusion(s): After adjusting for traditional arterial risk factors, renal function at baseline, but not change in eGFR over two years, was associated with prospective risk of ATE. This suggests that the duration of exposure to impaired renal function may play a role in the increased risk of ATE.