title: Antiphospholipid antibodies and hyperhomocysteinaemia in patients with vascular occlusive disease.
abstract: Hyperhomocysteinemia (HHcy), lupus anticoagulant (LA) and anticardiolipin antibodies (ACA) are independent risk factors for thrombosis. Even though risks are cumulative, the clinical impact of the association is unknown. Preliminary data suggested that HHcy might be associated with transient LA and ACA, disappearing after lowering HHcy. We prospectively evaluated the association of HHcy and LA/ACA, the effect of lowering HHcy with folic acid in LA behavior, and the correlation of the initial dRVVT with LA behavior after folic acid in 210 patients with thrombosis and adverse pregnancy outcomes. Prevalence of HHcy among patients with LA/ACA was 40%. Thirty-one patients exhibited only HHcy (15%; Group 1), 106 (50%; Group 2) had only LA/ACA, while 73 (35%; Group 3) had both. After therapy, 63% and 64% of LA/ACA remained positive in Group 3 and 2, respectively. We observed a trend towards a more positive dRVVT in persistent LA after lowering HHcy. No differences in clinical presentation or in outcomes after two years of followup were observed among the groups. Even though the association of HHcy and LA/ACA is common in patients with thrombosis, it might have no prognostic implications if Hcy levels are lowered. Currently, no laboratory findings correlate with LA behavior, which is independent of homocysteine levels and vitamin treatment.
authors.affiliation: Departamento de Hemostasia y Trombosis, Instituto de Investigaciones Hematologicas 'Mariano R. Castex', Academia Nacional de Medicina de Buenos Aires, Buenos Aires, Argentina. casais@hematologia.anm.edu.ar
authors.forename: Patricia
authors.initials: P
authors.lastname: Casais
authors.forename: Susana S
authors.initials: SS
authors.lastname: Meschengieser
authors.forename: Laura C
authors.initials: LC
authors.lastname: Gennari
authors.forename: Maria F
authors.initials: MF
authors.lastname: Alberto
authors.forename: Analia
authors.initials: A
authors.lastname: Sanchez-Luceros
authors.forename: Alicia N
authors.initials: AN
authors.lastname: Blanco
authors.forename: Maria A
authors.initials: MA
authors.lastname: Lazzari
mesh_terms: D000328:Adult; D000368:Aged; D017152:Antibodies, Antiphospholipid / Q000097:blood*; D001157:Arterial Occlusive Diseases / Q000097:blood / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005492:Folic Acid / Q000494:pharmacology; D005500:Follow-Up Studies; D006801:Humans; D020138:Hyperhomocysteinemia / Q000097:blood* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011248:Pregnancy Complications; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000097:blood* / Q000453:epidemiology* / Q000209:etiology
chemical_list: D017152:Antibodies, Antiphospholipid; D005492:Folic Acid