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Inicio Medicina Clínica (English Edition) Thrombocytopenia as a thrombotic risk factor in patients with antiphospholipid a...
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Vol. 148. Issue 9.
Pages 394-400 (May 2017)
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Vol. 148. Issue 9.
Pages 394-400 (May 2017)
Original article
Thrombocytopenia as a thrombotic risk factor in patients with antiphospholipid antibodies without disease criteria
Trombocitopenia como factor de riesgo trombótico en pacientes con anticuerpos antifosfolipídicos sin criterios de enfermedad
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Rosalia Demetrio Pabloa, Pedro Muñozb, Marcos López-Hoyosd, Vanesa Calvoc, Leyre Rianchoc, Victor Manuel Martínez-Taboadac,
Corresponding author
vmartinezt64@gmail.com

Corresponding author.
a Servicio de Oftalmología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Facultad de Medicina, Universidad de Cantabria, Santander, Spain
b Gerencia de Atención Primaria, Servicio Cántabro de Salud, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Facultad de Medicina, Universidad de Cantabria, Santander, Spain
c Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Facultad de Medicina, Universidad de Cantabria, Santander, Spain
d Inmunología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Facultad de Medicina, Universidad de Cantabria, Santander, Spain
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Tables (4)
Table 1. Demographic characteristics of the group of patients with thrombocytopenia versus the group without thrombocytopenia.
Table 2. Demographic, analytical and clinical characteristics of patients with thrombocytopenia.
Table 3. Obstetric outcome of thrombocytopenic pregnant women versus non-thrombocytopenic women in a total of 92 pregnancies.
Table 4. Comparison of the different studies published in population with idiopathic thrombocytopenic purpura and population with positive serology for antiphospholipid syndrome.
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Abstract
Introduction

The antiphospholipid syndrome (APS) is an acquired immune disorder defined by the presence of thrombosis (arterial and/or venous) and/or pregnancy morbidity along with the presence of positive antiphospholipid antibodies (aPL). There is a clear relationship between aPL and some events not included in the clinical criteria, including haematologic.

Objectives

(a) to study the probability of developing clinical APS in patients with positive aPL and thrombopenia; (b) to identify potential risk factors for thrombosis, and (c) to study the association between thrombocytopenia and aPL.

Methods

A retrospective study of 138 patients with positive aPL without fulfilling clinical criteria for APS. Thrombocytopenia was defined as a platelet count ≤100,000/μl. Patients with other causes of thrombocytopenia were excluded.

Results

Seventeen of the 138 (12%) patients in the study had thrombocytopenia. The mean platelet count was 60,000/μl. The risk of developing thrombocytopenia was higher in smokers (OR 2.8; p=0.044), in those with lupus anticoagulant (OR 13.5; p<0.001) and those with higher burden of aPL (OR 50.8; p<0.001). After a mean follow-up of 146±60.3 months, 5 patients with thrombocytopenia (29.4%) developed thrombosis.

Conclusions

In our series, the incidence of thrombocytopenia is 12%. aPL-positive patients who develop thrombocytopenia have a potential risk of developing thrombosis. Tobacco could be a risk factor for thrombocytopenia. Autoantibodies load is a risk factor for the development of thrombocytopenia.

Keywords:
Antiphospholipid syndrome
Thrombocytopenia
Antiphospholipid antibodies
Resumen
Introducción

El síndrome antifosfolípido (SAF) es un trastorno inmunitario adquirido, definido por la presencia de trombosis (arterial y/o venosa) y/o morbilidad del embarazo junto con la presencia de anticuerpos antifosfolipídicos (aFL) positivos. Existe una relación clara entre los aFL y algunas manifestaciones no incluidas en los criterios clínicos, entre ellas, las hematológicas.

Objetivos

a) estudiar la probabilidad de desarrollar SAF clínico en pacientes con aFL positivos y trombocitopenia; b) identificar posibles factores de riesgo para trombosis, y c) estudiar la asociación entre trombocitopenia y aFL.

Métodos

Estudio retrospectivo de 138 pacientes con aFL positivos sin cumplir criterios clínicos de SAF. Se definió trombocitopenia como una cifra de plaquetas ≤100.000/μl. Se excluyeron los pacientes con otras causas de trombocitopenia.

Resultados

Diecisiete de los 138 (12%) pacientes incluidos en el estudio presentaban trombocitopenia. La cifra media de plaquetas fue de 60.000/μl. El riesgo para desarrollar trombocitopenia fue mayor en los pacientes fumadores (OR 2,8; p=0,044), en aquellos con anticoagulante lúpico (OR 13,5; p<0,001) y en los que tenían una mayor carga de aFL (OR 50,8; p<0,001). Tras un seguimiento medio de 146±60,3 meses, 5 pacientes con trombocitopenia (29,4%) desarrollaron trombosis.

Conclusiones

En nuestra serie, la incidencia de trombocitopenia es del 12%. Los pacientes con aFL positivos que desarrollan trombocitopenia tienen un riesgo potencial de desarrollar trombosis. El tabaco podría ser un factor de riesgo para trombocitopenia. La carga de autoanticuerpos es un factor de riesgo para el desarrollo de trombocitopenia.

Palabras clave:
Síndrome antifosfolípido
Trombocitopenia
Anticuerpos antifosfolipídicos

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