title: Venous and Arterial Thrombotic Events in Systemic Lupus Erythematosus.
abstract: OBJECTIVE
  The incidence of thrombosis in patients with systemic lupus erythematosus (SLE) is 25 to 50-fold higher than in the general population; we aimed to define the characteristics of venous thrombotic events (VTE) and arterial thrombotic events (ATE) to identify the patients at highest risk.
  
  
  METHODS
  The study included 219 patients with recent-onset SLE. At baseline, standardized medical history and laboratory tests were done. Followup visits occurred quarterly, and information about damage accrual, comorbidities, and cardiovascular risk factors was updated annually. Main outcome was development of TE after SLE diagnosis.
  
  
  RESULTS
  Thirty-five patients (16%) developed TE (27 VTE, 8 ATE) during 5.21 years of followup; incidence rate 31/1000 patient-years. Most events (57%) developed within the first year of diagnosis, and 69% were not associated with lupus anticoagulant (LAC), determined with 1 method. VTE developed earlier than ATE (2.0 vs 57.5 mos, p = 0.02). In the multivariate analysis, variables preceding VTE included cutaneous vasculitis, nephrotic syndrome, dose of prednisone, and LAC in combination with anti-RNP/Sm antibodies (p < 0.03). Patients with ATE were older (median age 44 vs 29 yrs, p = 0.04), smokers, and had hypertension, diabetes mellitus, dyslipidemia, at least 2 traditional risk factors, nephrotic syndrome, chronic damage, and a higher cumulative dose of prednisone (p < 0.05). LAC in combination with anti-RNP/Sm antibodies was associated with VTE and improved the accuracy for predicting it.
  
  
  CONCLUSIONS
  Our study suggests that in SLE, VTE and ATE have different risk factors. Understanding these differences is helpful for identifying patients at highest risk. The use of LAC plus anti-RNP/Sm for predicting VTE deserves further study.
authors.affiliation: From the Department of Immunology and Rheumatology, and Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City; Division of Rheumatology, Mount Sinai Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada.A. Hinojosa-Azaola, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Romero-Diaz, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; A.G. Vargas-Ruiz, MD, Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C.A. Nuñez-Alvarez, BSc, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; A. Cicero-Casarrubias, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; M.C. Ocampo-Torres, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Sanchez-Guerrero, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, and Division of Rheumatology, Mount Sinai Hospital/University Health Network, University of Toronto.
authors.forename: Andrea
authors.initials: A
authors.lastname: Hinojosa-Azaola
authors.affiliation: From the Department of Immunology and Rheumatology, and Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City; Division of Rheumatology, Mount Sinai Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada.A. Hinojosa-Azaola, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Romero-Diaz, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; A.G. Vargas-Ruiz, MD, Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C.A. Nuñez-Alvarez, BSc, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; A. Cicero-Casarrubias, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; M.C. Ocampo-Torres, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Sanchez-Guerrero, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, and Division of Rheumatology, Mount Sinai Hospital/University Health Network, University of Toronto.
authors.forename: Juanita
authors.initials: J
authors.lastname: Romero-Diaz
authors.affiliation: From the Department of Immunology and Rheumatology, and Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City; Division of Rheumatology, Mount Sinai Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada.A. Hinojosa-Azaola, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Romero-Diaz, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; A.G. Vargas-Ruiz, MD, Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C.A. Nuñez-Alvarez, BSc, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; A. Cicero-Casarrubias, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; M.C. Ocampo-Torres, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Sanchez-Guerrero, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, and Division of Rheumatology, Mount Sinai Hospital/University Health Network, University of Toronto.
authors.forename: Angel Gabriel
authors.initials: AG
authors.lastname: Vargas-Ruiz
authors.affiliation: From the Department of Immunology and Rheumatology, and Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City; Division of Rheumatology, Mount Sinai Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada.A. Hinojosa-Azaola, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Romero-Diaz, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; A.G. Vargas-Ruiz, MD, Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C.A. Nuñez-Alvarez, BSc, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; A. Cicero-Casarrubias, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; M.C. Ocampo-Torres, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Sanchez-Guerrero, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, and Division of Rheumatology, Mount Sinai Hospital/University Health Network, University of Toronto.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Nuñez-Alvarez
authors.affiliation: From the Department of Immunology and Rheumatology, and Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City; Division of Rheumatology, Mount Sinai Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada.A. Hinojosa-Azaola, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Romero-Diaz, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; A.G. Vargas-Ruiz, MD, Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C.A. Nuñez-Alvarez, BSc, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; A. Cicero-Casarrubias, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; M.C. Ocampo-Torres, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Sanchez-Guerrero, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, and Division of Rheumatology, Mount Sinai Hospital/University Health Network, University of Toronto.
authors.forename: Alba
authors.initials: A
authors.lastname: Cicero-Casarrubias
authors.affiliation: From the Department of Immunology and Rheumatology, and Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City; Division of Rheumatology, Mount Sinai Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada.A. Hinojosa-Azaola, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Romero-Diaz, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; A.G. Vargas-Ruiz, MD, Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C.A. Nuñez-Alvarez, BSc, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; A. Cicero-Casarrubias, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; M.C. Ocampo-Torres, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Sanchez-Guerrero, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, and Division of Rheumatology, Mount Sinai Hospital/University Health Network, University of Toronto.
authors.forename: Mario C
authors.initials: MC
authors.lastname: Ocampo-Torres
authors.affiliation: From the Department of Immunology and Rheumatology, and Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City; Division of Rheumatology, Mount Sinai Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada.A. Hinojosa-Azaola, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Romero-Diaz, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; A.G. Vargas-Ruiz, MD, Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C.A. Nuñez-Alvarez, BSc, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; A. Cicero-Casarrubias, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; M.C. Ocampo-Torres, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Sanchez-Guerrero, MD, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, and Division of Rheumatology, Mount Sinai Hospital/University Health Network, University of Toronto. JSanchez-Guerrero@mtsinai.on.ca.
authors.forename: Jorge
authors.initials: J
authors.lastname: Sanchez-Guerrero
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D050171:Dyslipidemias / Q000150:complications*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D015994:Incidence; D020765:Intracranial Arterial Diseases / Q000453:epidemiology / Q000209:etiology*; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology*; D020246:Venous Thrombosis / Q000453:epidemiology / Q000209:etiology*; D055815:Young Adult
keywords: ANTI-RNP/Sm; LUPUS ANTICOAGULANT; SYSTEMIC LUPUS ERYTHEMATOSUS; THROMBOSIS