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Antiphospholipid Antibodies Not Predictive of Future Thrombo-Occlusive Events After Ischaemic Stroke

The presence of either anticardiolipin antibodies (aCL) or lupus anticoagulant antibodies (LA) at the time of an ischaemic stroke does not predict an increased risk for thrombo-occlusive events during the following 2 years, according to data from the Antiphospholipid Antibodies and Stroke Study (APASS).

The aim of APASS was to determine if positivity for antiphospholipid antibodies at the time of ischaemic stroke is predictive of death, ischaemic stroke, transient ischaemic attack, myocardial infarction, deep vein thrombosis, pulmonary embolism or other systemic thrombo-occlusive events.

For the study, principal investigator Steven R. Levine, MD, Mount Sinai School of Medicine, New York, United States, and colleagues prospectively analysed baseline blood samples of 1,770 subjects who participated in the Warfarin vs Aspirin Recurrent Stroke Study.

Overall, 720 patients, mean age of 63.1 years, were positive for antiphospholipid antibodies. Of these, 38% were women, 69% had ever smoked, 69% had hypertension, 32% had diabetes and 26% had cardiac disease. Of the 1,050 patients who were negative for antiphospholipid antibodies, mean age of 62.2 years, 45% were women, 63% were ever smokers, 69% had hypertension, 32% had diabetes and 21% had cardiac disease.

The overall cardiac event rate was 22.2% in patients positive and 21.8% in patients negative for antiphospholipid antibodies.

An analysis of the study population according to their treatment with either warfarin or aspirin revealed no increased risk of thrombo-occlusive events associated with baseline antiphospholipid antibodies status (relative risk 0.99 for those treated with warfarin and 0.94 for those treated with aspirin).

The investigators found that patients who tested positive for both aCL and LA had higher event rates at 2 years than patients who tested negative for both antibodies (31.67% and 23.95%, respectively). They note, however, that this finding was gleaned from a small subset of patients who were positive for both antibodies and therefore needs to be confirmed in larger studies.

"Our data from this large, prospectively studied cohort showed that testing for aCL or LA did not confer important knowledge for prognosis or for treatment," the authors conclude. This information, they add, "may apply to the ischaemic stroke population in general."
JAMA 2004;291:576-584.

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