The risk of ischaemic stroke in primary antiphospholipid syndrome patients: a prospective study

M. Radin, K. Schreiber, I. Cecchi, D. Roccatello, M. J. Cuadrado, S. Sciascia*

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Background and purpose: The most common neurological manifestation of antiphospholipid syndrome (APS) is ischaemic stroke. Identifying patients with APS at high risk for developing any thrombotic event remains a major challenge. In this study, the aim was to identify predictive factors of ischaemic stroke in a cohort of primary APS (PAPS) patients who presented with new onset symptoms suggestive of acute stroke. Methods: This prospective multicentre study included 36 consecutive PAPS patients who presented with new onset symptoms suggestive of an acute stroke. Patients were prospectively followed up for 12 months. Results: In 10 (28%) out of 36 PAPS patients [mean age 41 years (SD 13.4), 70% female], the suspicion of an acute stroke was confirmed by brain magnetic resonance imaging. Sixty per cent of these patients were <50 years old. Eight of the 10 patients had a history of previous venous thrombosis and were receiving vitamin K antagonist (VKA), with international normalized ratio target 2–3; one patient had a history of a previous arterial event receiving treatment with VKA target international normalized ratio 2–3 plus low dose aspirin; and one patient had a history of previous pregnancy morbidity receiving only low dose aspirin. Time in the therapeutic range for patients receiving VKA was 77.7% (SD 6.6%). Hypercholesterolaemia was significantly higher in patients with confirmed stroke compared to those without (P < 0.05). Similarly, a significantly higher rate of anti-β2 glycoprotein-I (β2GPI) antibodies (immunoglobulin G/immunoglobulin M; P < 0.05) and higher adjusted global APS score (aGAPSS) values were found in patients with a confirmed stroke [mean aGAPSS 8.9 (SD 4.7) vs. mean aGAPSS 6.4 (SD 2.5); P < 0.05]. Conclusions: Patients with PAPS, including young patients, have a high risk of recurrent thrombosis despite anticoagulation treatment. A careful risk assessment is mandatory to identify patients at risk for recurrence.

Original languageEnglish
JournalEuropean Journal of Neurology
Volume25
Issue number2
Pages (from-to)320-325
ISSN1351-5101
DOIs
Publication statusPublished - 1. Feb 2018
Externally publishedYes

Keywords

  • antiphospholipid syndrome
  • aPL
  • APS
  • GAPSS
  • risk score
  • stroke
  • thrombosis
  • Antiphospholipid Syndrome/complications
  • Prospective Studies
  • Stroke/diagnosis
  • Thrombosis/etiology
  • Humans
  • Middle Aged
  • Brain Ischemia/diagnosis
  • Male
  • Anticoagulants/therapeutic use
  • Hypercholesterolemia/diagnosis
  • Adult
  • Female
  • Risk Assessment/methods

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