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Blood, 15 September 2001, Vol. 98, No. 6, pp. 1760-1764
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Antiphospholipid antibodies and antiphospholipid syndrome in
patients presenting with immune thrombocytopenic purpura: a prospective
cohort study
Reyhan Diz-Küçükkaya,
Abdullah Hac hanefio lu,
Mustafa Yenerel,
Mehmet Turgut,
Hüseyin Keskin,
Meliha Nalçac, and
Murat  nanç
From the Divisions of Hematology and Rheumatology,
Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul
University, Turkey.
The pathogenetic role and the clinical importance of the presence
of antiphospholipid antibodies (APAs) in patients with immune thrombocytopenic purpura (ITP) are not clear. In this study, the prevalence and clinical significance of APAs were investigated in
patients with ITP. Eighty-two newly diagnosed ITP patients were
prospectively studied. They were evaluated for the presence of lupus
anticoagulant (LA) and immunoglobulin G/M anticardiolipin antibodies (ACAs). Thirty-one patients (37.8%) were APA positive at
diagnosis. No statistically significant differences were found between
the APA-positive and APA-negative groups regarding gender, initial
platelet counts, or response to methylprednisolone therapy. After 5 years of follow-up, cumulative thrombosis-free survival of APA-positive
(n = 31) and APA-negative (n = 51) ITP patients was 39% and
97.7%, respectively. A significant difference was found between these
groups by log-rank test (P = .0004). In addition, LA was
an important risk marker for the development of thrombosis in ITP
patients. After a median follow-up of 38 months, 14 ITP patients (45%)
who had APA positivity developed clinical features (thrombosis or fetal
losses) of antiphospholipid syndrome (APS). There were no differences
between the APA-positive patients with and without APS regarding the
initial platelet counts, response to the therapy, or ACA positivity.
The positivity rate for LA was significantly higher in those patients
with ITP who developed APS ( 2: P = .0036;
relative risk 7.15; 95% confidence interval, 1.7-47). In conclusion,
this study indicates that a significant proportion of patients
initially presenting with ITP and APA positivity developed APS. In
patients with ITP, the persistent presence of APAs is an important risk
factor for the development of APS.
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