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Anti-Phosphatidylserine-Prothrombin Antibodies are Associated with Outcome in a TIA Cohort.

ABSTRACT: BACKGROUND:Antiphospholipid antibodies (aPLs) have been associated with thrombosis in the antiphospholipid antibody syndrome (APS) and with atherosclerotic vascular events in patients without APS. We examined the significance of aPLs in transient ischemic attack (TIA). PATIENTS/METHODS:Patients with TIA <48?h from symptom onset were prospectively enrolled. Traditional aPLs, including anticardiolipin and ?2-glycoprotein-I (?2GPI), and newer aPLs, including anti-phosphatidylserine/prothrombin (aPS/PT), ?2GPI Domain 4/5 and ?2GPI Domain 1 were measured. Primary outcome was a composite of stroke or death within 90?days or identification of a high risk stroke mechanism. Secondary outcomes were stroke or death and the presence of clinical/sub-clinical atherosclerosis. RESULTS:Over 4.5?years, 167 patients were enrolled. Forty one patients (25%) had the composite endpoint. Antibodies were measured in 158 subjects. aPS/PT IgG antibodies were significantly associated with stroke/death (OR 16.3, 95% CI 2.3-116.7, p?=?0.005) and were non-significantly associated with the composite endpoint (OR 4.7, 95% CI 0.8-29.2, p?=?0.10). In multivariate analysis adjusting for ABCD(2) risk score, aPS/PT IgG remained associated with stroke/death (OR 15.7, 95% CI 2.0-125.6, p?=?0.009). Other aPLs were not associated with clinical outcome and no association between APLs and atherosclerosis was identified. CONCLUSION:In contrast to other aPLs, aPS/PT IgG antibodies are independently associated with stroke or death in patients with TIA.

SUBMITTER: Mullen MT

PROVIDER: S-EPMC3460224 | biostudies-literature | 2012

REPOSITORIES: biostudies-literature

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Anti-Phosphatidylserine-Prothrombin Antibodies are Associated with Outcome in a TIA Cohort.

Mullen Michael T MT Messé Steven R SR Kasner Scott E SE Sansing Lauren L Husain M R MR Norman Gary L GL Shums Zakera Z Cucchiara Brett L BL

Frontiers in neurology 20120928

<h4>Background</h4>Antiphospholipid antibodies (aPLs) have been associated with thrombosis in the antiphospholipid antibody syndrome (APS) and with atherosclerotic vascular events in patients without APS. We examined the significance of aPLs in transient ischemic attack (TIA).<h4>Patients/methods</h4>Patients with TIA <48 h from symptom onset were prospectively enrolled. Traditional aPLs, including anticardiolipin and β2-glycoprotein-I (β2GPI), and newer aPLs, including anti-phosphatidylserine/p ...[more]

PMID: 23060855

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Project description:Fibrinogen and prothrombin have been suggested to become rate limiting in trauma associated coagulopathy. Administration of fibrinogen is now recommended, however, the importance of prothrombin to patient outcome is unknown.We have utilized two trauma patient databases (database 1 n?=?358 and database 2 n?=?331) to investigate the relationship of plasma prothrombin concentration on clinical outcome and coagulation status. Database 1 has been used to assess the relationship of plasma prothrombin to administered packed red blood cells (PRBC), clinical outcome and coagulation biomarkers (Prothrombin Time (PT), ROTEM EXTEM Coagulation Time (CT) and Maximum Clot Firmness (MCF)). ROC analyses have been performed to investigate the ability of admission coagulation biomarkers to predict low prothrombin concentration (database 1), massive transfusion and 24 h mortality (database 1 and 2). The importance of prothrombin was further investigated in vitro by PT and ROTEM assays in the presence of a prothrombin neutralizing monoclonal antibody and following step-wise dilution.Patients who survived the first 24 h had higher admission prothrombin levels compared to those who died (94 vs.67 IU/dL). Patients with lower transfusion requirements within the first 24 h (?10 units of PRBCs) also had higher admission prothrombin levels compared to patients with massive transfusion demands (>10 units of PRBCs) (95 vs.62 IU/dL). Admission PT, in comparison to admission ROTEM EXTEM CT and MCF, was found to be a better predictor of prothrombin concentration <60 IU/dL (AUC 0.94 in database 1), of massive transfusion (AUC 0.92 and 0.81 in database 1 and 2 respectively) and 24 h mortality (AUC 0.90 and 0.78 in database 1 and 2, respectively). In vitro experiments supported a critical role for prothrombin in coagulation and demonstrated that PT and ROTEM EXTEM CT are sensitive methods to measure low prothrombin concentration.Our analyses suggest that prothrombin concentration at admission is predictive of mortality and transfusion and indicates that prothrombin and fibrinogen are rate limiting in coagulopathy.Admission PT is predictive of low prothrombin concentration and clinical outcome. PT could therefore be used as a surrogate for prothrombin concentration and further evaluation of point-of-care devices for faster PT analysis is warranted.

Dataset Information

Anti-Phosphatidylserine-Prothrombin Antibodies are Associated with Outcome in a TIA Cohort.

Publications

Anti-Phosphatidylserine-Prothrombin Antibodies are Associated with Outcome in a TIA Cohort.

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