STROKE: THE MAIN INITIAL AND RECURRENCE CLINICAL MANIFESTATION IN PRIMARY APS PATIENTS OLDER THAN 70 YO IN A SERIES OF 696 PATIENTS
- Cristina Belizna, France
Abstract
Background and Aims
To analyse the clinical and laboratory data and outcomes on a cohort of patients with primary antiphospholipid syndrome (APS) of late onset after 70 years old as compared with younger primary APS.
Methods
The International Registry of primary APS treated with Hydroxychloroquine, HIBISCUS, became a registry within the framework of the European Forum on Antiphospholipid Antibody projects. 55 centres from 16 countries around the world have collaborated and included patient’s data in this registry. Patients with primary APS which fulfilled the Sydney classification criteria, presenting thrombotic and obstetric manifestations related to antiphospholipid antibodies (aPL) who tested positive for aPL at least twice, were included prospectively and retrospectively. The five-year survey results are reported.
Results
The HIBISCUS register includes 851 patients. Relevant data were analysed on 698 patients. Mean follow-up was 39.4 months (9- 68 mo) and mean age 42.5 years old (18-82). Two groups of patients were analyzed : younger than 70 yo and older than 70 yo. Arterial events end especially stroke represented the main initial and recurrence clinical manifestation in older primary APS patients; as well as a significant male predominance, a familial APS history, a higher prevalence of triple positivity, lower C3 and C4. Traditional cardiovascular risk factors and inflammation were similar in both groups. Lower anticoagulation strategies were well tolerated and efficient in older APS patients.
Conclusions
We suggest that the detection of aPL should be included into the screening panel in elderly with thrombotic events and that lower intensity anticoagulation regimens could be a therapeutic option in older APS.