title: Risk of venous and arterial thrombosis according to type of antiphospholipid antibodies in adults without systemic lupus erythematosus: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To evaluate the magnitude of venous and arterial thrombosis risk associated with antiphospholipid antibodies (APLs) in adults without systemic lupus erythematosus (SLE).
  
  
  METHODS
  Case-control and cohort studies were selected from the MEDLINE and Cochrane Library databases. Two investigators independently extracted data on study design, patient characteristics, venous and arterial events and exposure to APLs, including lupus anticoagulant (LA), anticardiolipin (aCL), anti-β2 Glycoprotein I (β2GpI), anti-prothrombin (aPT), anti-phosphatidyl serine (aPS), and anti-phosphatidyl ethanolamine (aPE).
  
  
  RESULTS
  30 studies were included (16,441 patients). The odds ratio (OR) for venous thrombosis was 6.14 (95% confidence interval [CI] 2.74-13.8) in LA-positive patients (5 studies, 1650 patients) and 1.46 (CI 1.06-2.03) in aCL-positive patients (12 studies, 5375 patients). None of the associations with more recently identified APLs was significant, but fewer studies were available. For arterial thrombosis, the OR for LA and aCL was 3.58 (CI 1.29-9.92) and 2.65 (CI 1.75-4.00) respectively. The associations between β2GpI, aPT and aPS and the risk of arterial thrombosis were also significant, the OR being 3.12 (CI 1.51-6.44), 2.95 (CI 1.31-6.66) and 6.00 (CI 3.07-11.7), respectively. Owing to the heterogeneity of cut-off values for each APL assay, we were unable to perform any sensitivity analysis to determine the optimal value. The presence of low-quality studies may have led to overestimation of the magnitude of the associations.
  
  
  CONCLUSIONS
  LA and aCL were significantly associated with an increased risk of thrombosis, especially arterial, in patients without SLE. Systematic thromboprophylaxis in high-risk patients with APL should be evaluated.
authors.affiliation: Service de Médecine Interne, CHU Saint-Etienne, France.
authors.forename: Quitterie
authors.initials: Q
authors.lastname: Reynaud
authors.affiliation: Service de Médecine Interne et Vasculaire, Centre Hospitalier Lyon Sud, Université Claude Bernard Lyon 1, Lyon, France; EA3065, Université Jean Monnet, F-42023 Saint-Etienne, France. Electronic address: jean-christophe.lega@chu-lyon.fr.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Lega
authors.affiliation: EA3065, Université Jean Monnet, F-42023 Saint-Etienne, France; Unité de Recherche Clinique, Innovation et Pharmacologie, CHU Saint-Etienne, France; Service de Médecine et Thérapeutique, CHU Saint-Etienne, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Mismetti
authors.affiliation: Unité de Recherche Clinique, Innovation et Pharmacologie, CHU Saint-Etienne, France; INSERM, CIE3, F-42055 Saint-Etienne, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Chapelle
authors.affiliation: Unité de Médecine Vasculaire, Centre de Compétence Régional des Maladies Vasculaires Rares Systémiques et Auto-immunes, CHU Nancy, France; INSERM, UMR-S1116, Défaillances cardiovasculaires aigues et chroniques, Université de Lorraine, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Wahl
authors.affiliation: Service de Médecine Interne, CHU Saint-Etienne, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Cathébras
authors.affiliation: EA3065, Université Jean Monnet, F-42023 Saint-Etienne, France; Unité de Recherche Clinique, Innovation et Pharmacologie, CHU Saint-Etienne, France; INSERM, CIE3, F-42055 Saint-Etienne, France.
authors.forename: Silvy
authors.initials: S
authors.lastname: Laporte
mesh_terms: D000328:Adult; D017152:Antibodies, Antiphospholipid / Q000032:analysis / Q000276:immunology*; D016736:Antiphospholipid Syndrome / Q000150:complications / Q000276:immunology*; D016022:Case-Control Studies; D015331:Cohort Studies; D006801:Humans; D016682:Lupus Coagulation Inhibitor; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000276:immunology; D012307:Risk Factors; D013927:Thrombosis / Q000276:immunology*; D053482:beta 2-Glycoprotein I
chemical_list: D017152:Antibodies, Antiphospholipid; D016682:Lupus Coagulation Inhibitor; D053482:beta 2-Glycoprotein I
keywords: Anti-phospholipid antibodies; Antiphospholipid syndrome; Arterial thrombosis; Deep venous thrombosis; Meta-analysis; Pulmonary embolism