Abstract
Potential Markers of Arterial and/or Venous Thromboses and their Complications in Primary Antiphospholipid SyndromeAntiphospholipid syndrome is characterized by venous or arterial thromboses and/or recurrent abortions accompanied by antiphospholipid antibodies and it can be primary (PAPS) or secondary (SAPS) to another disease. Arterial thromboses are less common than venous and most frequently they manifest as ischemia or infarction. Venous thromboses are usually multiple and bilateral and the most common complication of venous thromboses are pulmonary emboli. Considering that laboratory diagnosis of PAPS is currently based on persistently positive aCL, aβ2gpl and/or LA tests, and that neither one of those tests can discriminate between PAPS patients with arterial or venous thromboses or their complications, the aim of this study was to investigate the diagnostical significance of the determination of apo(a), oxLDL, anti-oxLDL antibodies, antianxA5 antibodies, hsCRP, C3 and C4 complement components and HPT for discrimination between PAPS patients with diverse clinical manifestations. Considering that elevated oxLDL and anti-oxLDL antibodies concentrations were found in PAPS patients, and also in subgroups of PAPS patients with MI or PE, it can be concluded that those parameters represent additional risk factors which together with other factors may lead to thromboses and their complications in PAPS. Regarding the fact that C3 and C4 concentrations were decreased in PAPS patients and that a positive correlation was found between hsCRP and C3 concentrations, this finding could indicate potential roles of these parameters as markers of atherosclerosis, which represents the leading cause of morbidity and mortality. HPT and apo(a) concentrations are not independent risk factors for MI in PAPS because lower levels were found in those patients in comparison to MI survivors without PAPS. No significant correlation of anti-anxA5 antibodies and the presence of arterial or venous thromboses or their complications was found, but increased concentrations of the IgG isotype of those antibodies could be a marker for recurrent abortions in PAPS, although this finding should be further investigated on a larger number of patients with this clinical finding. Determination of hsCRP in PAPS patients could not be an adequate parameter which would provide discrimination between patients with increased risk for development and/or recurrence of venous and/or arterial thromboses, nor for their complications, because no statistically significant difference in concentrations of this parameter was found among PAPS, IM, PE and SLE patients who were included in this study.
Highlights
Antiphospholipid syndrome is characterised by venous or arterial thromboses and/or recurrent abortions accompanied by antiphospholipid antibodies, and it can be primary (PAPS) or secondary (SAPS) to another disease [1,2,3,4].Recurrent thromboses are the major clinical manifestation of APS and they can involve blood vessels of any organ
Regarding the fact that C3 and C4 concentrations were decreased in primary antiphospholipid syndrome (PAPS) patients and that a positive correlation was found between hsCRP and C3 concentrations, this finding could indicate potential roles of these parameters as markers of atherosclerosis, which represents the leading cause of morbidity and mortality
No significant correlation of anti-anxA5 antibodies and the presence of arterial or venous thromboses or their complications was found, but increased concentrations of the IgG isotype of those antibodies could be a marker for recurrent abortions in PAPS, this finding should be further investigated on a larger number of patients with this clinical finding
Summary
Antiphospholipid syndrome is characterised by venous or arterial thromboses and/or recurrent abortions accompanied by antiphospholipid antibodies, and it can be primary (PAPS) or secondary (SAPS) to another disease [1,2,3,4]. The frequency of cardiac valvular abnormalities appears to be quite high, with echocardiography revealing at least one valvular abnormality in up to 63% of patients with APS Many of these abnormalities are of little clinical consequence, vegetations of the mitral or aortic valves are present in approximately 4% of patients with PAPS or SAPS [5, 6]. Cardiac manifestations of APS are valve abnormalities (valve thickening, vegetations, and dysfunction), thrombotic and atherosclerotic coronary occlusion, ventricular hypertrophy and dysfunction, intracardiac thrombus and pulmonary hypertension. Venous thromboses are more common than arterial thromboses and they are present in 65 –75% of patients with APS. Considering that laboratory diagnosis of PAPS is currently based on persistently positive aCL, ab2gpI and/or LA tests, and that neither one of those tests can discriminate between PAPS patients with arterial or venous thromboses or their complications, it is important to evaluate the diagnostic significance of the determination of apo(a), oxLDL, anti-oxLDL antibodies, anti-anxA5 antibodies, hsCRP, C3 and C4 complement components and HPT for discrimination between PAPS patients with diverse clinical manifestations
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