Lupus anticoagulant in systemic lupus erythematodes as risk factor for cryptogenic stroke

Abstract number: P1533

Kahles^* T., Humpich^* M., Sitzer^* M., Lindhoff-Last^* E.

^*University Hospital Frankfurt, Germany

Background and purpose  

Antiphospholipid antibodies (APLA) are established risk factors for thrombosis and may also be associated with otherwise not explained (‘cryptogenic’) cerebral ischemia.

Methods  

All cryptogenic stroke patients (n = 21, group A) admitted to our Stroke Unit over a 2-year period of time were included in the present study. As control groups, we examined n = 104 stroke patients with a determined cause of stroke (according to TOAST classification; B), and n = 84 blood donors (C) without any thrombotic or ischemic event in their history. Sera were tested for lupus anticoagulants (LA) using phospholipid-dependent coagulation tests (aPTT, DRVVT). Confirmatory tests were performed if necessary. Furthermore, we assessed the presence of specific APLA against phosphatidylserine, cardiolipin, and b2-glycoprotein I using ELISA.

Results  

The median age was 52 years in group A, 60 years in B, and 51 years in C, respectively. Within the first 14 days after stroke onset, the prevalence of LA was 3/21 in group A and 4/104 in group B (P = 0092). In contrast, the prevalence of persisting LA (>6 weeks) was significantly higher in group A (2/21) in comparison to B (0/104; P = 0027), and C (0/84; P = 0038), respectively. The two patients with persisting LA in group A fulfilled ARA criteria for systemic lupus erythematodes. For APLA except antiphosphatidylserine no significant differences emerged between groups. The moderate elevation of antiphosphatidylserine-antibodies in the two stroke groups compared to the control group may be induced by acute phase reaction.

Conclusion  

Despite the occurrence of LA in the context of systemic lupus erythematodes (‘secondary antiphospholipid syndrome’), our data do not support an independent and major role of APLA in stroke etiology.