Anticardiolipin antibodies in young Iraqi adults with deep venous thrombosis

ABSTRACT

To determine the prevalence and clinical significance of anticardiolipin antibodies [ACA] in young Iraqis with Deep venous thrombosis [DVT]. A total of 50 unselected young Iraqi adults [<45 years] with Doppler confirmed DVT were evaluated. The evaluation included full relevant history, Prothrombin Time, Partial Thromboplastin Time, Kaolin Clotting time [KCT], KCT index [to screen for Lupus Anticoagulant [LA] in patients not on oral anticoagulants], and lgG and IgM ACA titres [by ELISA]. The median age of the DVT patients was 32.5 years with a MF ratio of 12.6. The overall prevalence of Antiphopholipid Antibodies [APA] [those with elevated ACA and/or LA] was 16%, while it was 9.5% in the subcategory with single DVT attack. The subcategory of patients with recurrent DVT [8 patients] had significantly higher frequency of APA [OR 9.5] and lgG ACA titres compared to those with a single episode [p=0.01583 and 0.01 respectively]. Higher frequencies of APA were also encountered in the subcategories with history of Pulmonary embolism, Stroke and recurrent fetal loss, compared to those without such histories [OR of 3.2, 6.7 and 7.7 respectively]. The findings of this study are consistent with worldwide reports on prevalence and significance of APA. The high frequency of these antibodies in young Iraqi patients and their association with recurrent thrombotic events, in addition to the bulk of the literature suggesting higher recurrence rates and mortality in those with the antibodies on cessations of therapy, warrants pursuing the policy of evaluating all Iraqi young adults at diagnosis or just prior stopping therapy for APA, and considering long term appropriate anticoagulation in those with the antibodies, to reduce recurrence and mortality