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KMID : 1044520190820010053
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Tuberculosis and Respiratory Diseases
2019 Volume.82 No. 1 p.53 ~ p.61
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Clinical Phenotype of a First Unprovoked Acute Pulmonary Embolism Associated with Antiphospholipid Antibody Syndrome
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Na Yong-Sub
Jang Seong-Soo
Hong Seok-Chan
Oh Yeon-Mok
Lee Sang-Do
Lee Jae-Seung
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Abstract
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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.
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KEYWORD
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Antiphospholipid Syndrome, Antibodies, Antiphospholipid, Pulmonary Embolism, Phenotype, Risk Factors
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