Increased mortality in patients with the lupus anticoagulant: The vienna lupus anticoagulant and thrombosis study (LATS)

Abstract

Data on the clinical course of lupus anticoagulant (LA)-positive individuals with or without thromboticmanifestations or pregnancy complications are limited. To investigate mortality rates and factors that might influence mortality, we conducted a prospective observational study of LA-positive individuals. In total, 151 patients (82% female) were followed for a median of 8.2 years; 30 of the patients (20%) developed 32 thromboembolic events (15 arterial and 17 venousevents) and20patients (13%) died. Inunivariable analysis, new on set of thrombosis (hazard ratio [HR] 5 8.76; 95% confidence interval [CI], 3.46-22.16) was associated with adverse survival. Thrombosis remained a strong adverse prognostic factor after multivariable adjustment for age and hypertension (HR 5 5.95; 95% CI, 2.43-14.95). Concomitant autoimmune diseases, anticoagulant treatment at baseline, or positivity for anticardiolipin-or anti-β2-glycoprotein I antibodies were not associated with mortality. In a relative survival analysis, our cohort of LA positives showed a persistentlyworse survival in comparison with an age-, sex-, and study-inclusion-year-matched Austrian reference population. The cumulative relative survival was 95.0% (95% CI, 88.5-98.8) after 5 years and 87.7% (95% CI, 76.3-95.6) after 10 years.We conclude that occurrence of a thrombotic event is associated with highermortality in patients with LA. Consequently, the prevention of thromboembolic events in LA positives might improve survival.