| Institution |
Department of Neurology, Albany Medical Center, Albany, N.Y Stroke Center and Departments of Neurology and Emergency Medicine, State University of New York Downstate Medical Center, and Department of Neurology, Kings County Hospital Center, Brooklyn, N.Y Department of Neurology, University of Texas Health Science Center, San Antonio, Tex Public Health Sciences, Medical University of South Carolina, Charleston, S.C Department of Biostatistics, School of Public Health, University of Texas-Houston, Houston, Tex Health Care Leadership and Management, Medical University of South Carolina, Charleston, S.C Department of Neurology, Miller School of Medicine, University of Miami, Miami, Fla Department of Neurology, Icahn School of Medicine at Mount Sinai, and Stroke Center, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, N.Y., USA |
| Abstract |
Background: There are very limited prospective data on the significance of persistent antiphospholipid antibodies (aPL) and recurrent thrombo-occlusive events (TOEs). We investigated the prognostic value of (1) 2 newer aPL assays, (2) an aPL portfolio and (3) persistent aPL positivity following stroke. Methods: A total of 1,770 subjects from the APASS-WARSS study underwent further aPL testing for antibodies to phosphatidylserine (aPS) and anti-β2-glycoprotein-I (anti-β2GPI) from stored sera. Follow-up aPL status was also tested in a subset of subjects. Primary analysis was based on time to any TOE (ischemic stroke, myocardial infarction, transient ischemic attack, deep vein thrombosis, pulmonary embolism or systemic arterial occlusion)/death at 2 years. Cox proportional hazard analyses assessed whether aPL independently related to outcome. Results: Persistent anti-β2GPI decreased the time to TOE/death after adjustment for potential confounders (hazards ratio (HR) 2.86, 95% CI 1.21-6.76, p = 0.017). When persistent anti-β2GPI was combined with another persistently positive aPL, time to TOE/death was also reduced (HR 3.79, 95% CI 1.18-12.14, p = 0.025). Neither persistent anticardiolipin antibodies nor persistent aPS alone nor a single positive anti-β2GPI nor aPS was associated with decreased time to TOE/death. No single positive aPL, portfolio of baseline aPL or any persistent aPL increased the rate of TOE/death. Conclusions: Rates of TOE/death were not influenced by aPL results at baseline or follow-up. Persistent anti-β2GPI alone, and with persistent second aPL, was independently associated with decreased time to TOE/death. Persistent aPL, an aPL portfolio and newer aPL in ischemic stroke patients are not helpful in predicting an increased rate of recurrent TOEs.
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