Antiphospholipid antibodies in venous thromboembolism patients younger than 50 years old

Antiphospholipid antibodies are among the most important risk factors of arterial and venous thrombosis. Various studies have demonstrated that these antibodies are seen in patients with deep vein thrombosis [DVT] and pulmonary embolism [PE] more than normal individuals but there are a few studies about prevalence of these antibodies in patients younger than 50 years old with venous thromboembolism [VTE]. This study aimed to evaluate these antibodies in this age group. This was a case-control study. Fifty patients younger than 50 years old with venous thromboembolism [DVT, PE or both] who were diagnosed according to the standard criteria were compared with 48 subjects in the control group. Subjects in the control group were age and sex matched with patients and had no history of venous thromboembolism. Both groups had no history of malignancy or other chronic diseases. Lupus anti-coagulant and serum anticardiolipin antibodies [IgG and IgM] were measured in both groups. Data were analyzed using SPSS version 11.5 software. Fifty VTE patients younger than 50 years of age enrolled in this study [28 males and 22 females; mean age: 38.14 +/- 6.5 yrs]. Forty-eight subjects were selected as healthy controls [27 males and 21 females; mean age: 38.35 +/- 5.06 yrs]. Mann-Whitney test showed a significant difference between serum IgM anticardiolipin antibody levels of VTE patients [8.04 MPL units/ml] and those of healthy subjects [1.85 MPL units/ml] [P=0.001]. Also, a significant difference was found between serum IgG anticardiolipin antibody levels of VTE patients [8.29 GPL units/ml] and those of healthy subjects [3.51 GPL units/ml] [P=0.001]. In VTE group, 7 patients [M/F=4/3] had an IgG level >10 GPL units/ml and 6 patients [M/F=2/4] had an IgM level >10 MPL units/ml while none of the healthy subjects had IgG or IgM levels higher than 10 [P[IgM] = 0.015 and P[IgG] = 0.007]. Lupus anti-coagulant was positive in four [8%] but negative in all healthy subjects [P=0.04]. This study demonstrated that antiphospholipid antibodies were more prevalent in VTE patients younger than 50 years old compared to healthy subjects. Considering the fact that these patients need stronger and longer treatment, it seems necessary to evaluate every VTE patient younger than 50 yrs for antiphospholipid syndrome

Avaliação clínica e laboratorial da trombose venosa em pacientes com câncer de pulmão / Clinical and laboratory evaluation of venous thrombosis in patients with lung cancer

INTRODUÇÃO: A trombose é um fenômeno frequente nos pacientes portadores de neoplasias e está relacionada com o prognóstico dos mesmos. No entanto, até os dias de hoje, a real incidência de trombose e os mecanismos relacionados ainda não estão totalmente elucidados. MÉTODOS: O presente estudo acompanhou, de forma prospectiva e consecutiva, 120 pacientes portadores de adenocarcinoma de pulmão em diferentes estágios da doença. Nestes pacientes foram testados ao diagnóstico e a cada 6 meses, marcadores da coagulação (TAP, PTT, fibrinogênio, D-dímero, proteína C, antitrombina, fatores (VIII e IX) e plaquetas) além de parâmetros imunológicos (presença de anticorpos anticardiolipina, anticoagulante lúpico, anti B2 glicoproteína l, níveis de interleucinas (1 e 6) e fator de necrose tumoral). Os mesmos foram acompanhados a cada 3 meses (no caso de sintomas) com pesquisa de trombose em membros inferiores e superiores (e no caso de suspeita, pesquisa de embolia pumonar). Daqueles pacientes dos quais se obteve o bloco de diagnóstico, também foi feito estudo da expressão de fator tecidual e receptores PAR1. RESULTADOS: Trombose foi um evento frequente (24% dos pacientes) e esteve relacionada com uma pior sobrevida. Em análise univariável, a presença de altos níveis de interleucina-6, fatores VIII e IX, fibrinogênio, além de presença de anticorpo anticoagulante lúpico, estiveram relacionados com o aumento de eventos trombóticos. Porém, em análise multivariável, apenas o anticoagulante lúpico manteve-se como fator de risco. Por outro lado, a presença de anticorpos anti B2 glicoproteína l do tipo IgM não só reduziu o risco de eventos trombóticos como também aumentou a sobrevida dos pacientes. A presença da expressão de fator tecidual esteve mais frequente nas fases avançadas da doença, enquanto a expressão de PAR foi maior em estados iniciais. Ambos não mostraram influenciar de forma significativa o risco de trombose e mortalidade...

INTRODUCTION: Thrombosis is a frequent event on cancer patients and are related to their prognosis. However, until now the real incidence and their mechanism are still not fully elucidated. METHODS: We studied prospectively and consecutively 120 patients with lung adenocarcinoma in different disease stages. Those patients made blood evaluation at diagnosis and each 6 month each for clotting (TAP, TPP, fibrinogen, D-dimmer, Protein C, antithrombin, platelets and clotting factors VIII and IX) than immunologic markers (anticardiolipin antibodies, lupus anticoagulant, anti B2 glicoproteín I, interleukin 1 and 6 and Tumor Necrosing Factor Levels). The same patients were submitted to limb and arms Doppler scan each 3 month to screening for thrombosis and if suspected of pulmonary embolism it was screened). From those patients of witch paraffin block of tumor biopsy were obtained, immunohistochemical analysis were made to detect tissue factor and PAR1 expression. RESULTS: Thrombosis were a frequent event (24% of patients), and were related to survival (independently if symptomatic or not). Univariable analysis showed that high levels of interleukin 6, fibrinogen, factors VIII or XI and lupus anticoagulant detection increases thrombosis risk. However in multivariable analysis, only lupus anticoagulant antibodies maintain as risk factor of thrombosis. But, despite be from antiphospholipid family, IgM anti B2 glicoproteín l decreased thrombosis risk and increase patients' survival as compared for those patients without those antibodies. Tissue factor expression was more evident on advanced stage of disease and PAR expression in early stages. However neither tissue factor nor PAR changes in a significantly manner patient's survival (however, the number of patients samples studied is small). CONCLUSION: Venous thrombosis is very frequent in lung adenocarcinoma patients. In our study, we show interaction between both systems (clotting and immunologic)...

prevalence of anti-phospholipid autoantibodies in patients with deep venous thrombosis

The aim of the study was to determine the prevalence of antiphospholipid autoantibodies [APLAs] among patients with deep vein thrombosis [DVT]. The APLAs tested were lupus anticoagulant [LA], anticardiolipin [aCL], anti- beta 2 glycoprotein I dependent [a beta 2-GPI], and anti-phosphatidyl serine [aPS]. This study was carried out on 50 patients suffering from DVT events and 30 healthy individuals as a control during the period between 1st March 2004 and 1st March 2005. The studied cases were under 50 years of age, and had no recognizable risk factors. The activated partial thromboplastin time [APTT] was used for LA estimation and ELISA assay was used to test for IgG and IgM isotypes of tested APLAs. The DVT events with significant APLAs was detected in 20/50 [40%] of patients. A significant titers of LA [P > 0.05], total IgG aCL isotype [P > 0.025], and IgG a beta 2-GPI [P > 0.025] were detected in the studied cases, while the correlation was lacking for IgG aPS. The LA, aCL, and a beta 2- GPI significant titers were found to be predominant in DVT patients. Therefore, a panel testing for APLAs is a prudent to correlate such DVT cases as a clinical event related to antiphospholipid syndrome [APS]

Transient low levels of antibodies at initial presentation of primary anti-phospholipid syndrome.

We present, herein, a case of venous thrombosis who was lupus anticoagulant negative and had low levels of anticardiolipin antibodies at the time of initial presentation. A definite diagnosis of antiphospholipid syndrome (APS) could be made only when repeat testing, six months later, revealed a dramatic rise of these antibodies.