Clinical Phenotype of a First Unprovoked Acute Pulmonary Embolism Associated with Antiphospholipid Antibody Syndrome.
- Author:
Yong Sub NA
1
;
Seongsoo JANG
;
Seokchan HONG
;
Yeon Mok OH
;
Sang Do LEE
;
Jae Seung LEE
Author Information
- Publication Type:Original Article
- Keywords: Antiphospholipid Syndrome; Antibodies, Antiphospholipid; Pulmonary Embolism; Phenotype; Risk Factors
- MeSH: Antibodies, Antiphospholipid*; Antiphospholipid Syndrome*; Chungcheongnam-do; Demography; Hemoptysis; Humans; Logistic Models; Partial Thromboplastin Time; Phenotype*; Pregnancy; Pulmonary Embolism*; Recurrence; Retrospective Studies; Risk Factors; Thrombophilia; Thrombosis
- From:Tuberculosis and Respiratory Diseases 2019;82(1):53-61
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND: Antiphospholipid antibody syndrome (APS), an important cause of acquired thrombophilia, is diagnosed when vascular thrombosis or pregnancy morbidity occurs with persistently positive antiphospholipid antibodies (aPL). APS is a risk factor for unprovoked recurrence of pulmonary embolism (PE). Performing laboratory testing for aPL after a first unprovoked acute PE is controversial. We investigated if a specific phenotype existed in patients with unprovoked with acute PE, suggesting the need to evaluate them for APS. METHODS: We retrospectively reviewed patients with PE and APS (n=24) and those with unprovoked PE with aPL negative (n=44), evaluated 2006–2016 at the Asan Medical Center. We compared patient demographics, clinical manifestations, laboratory findings, and radiological findings between the groups. RESULTS: On multivariate logistic regression analysis, two models of independent risk factors for APS-PE were suggested. Model I included hemoptysis (odds ratio [OR], 12.897; 95% confidence interval [CI], 1.025–162.343), low PE severity index (OR, 0.948; 95% CI, 0.917–0.979), and activated partial thromboplastin time (aPTT; OR, 1.166; 95% CI, 1.040–1.307). Model II included age (OR, 0.930; 95% CI, 0.893–0.969) and aPTT (OR, 1.104; 95% CI, 1.000–1.217). CONCLUSION: We conclude that patients with first unprovoked PE with hemoptysis and are age <40; have a low pulmonary embolism severity index, especially in risk class I–II; and/or prolonged aPTT (above 75th percentile of the reference interval), should be suspected of having APS, and undergo laboratory testing for aPL.
