Inflammatory markers in thrombosis associated with primary antiphospholipid syndrome
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Inflammatory markers in thrombosis associated with primary antiphospholipid syndrome Fernanda T. Arantes1 · Bruna M. Mazetto1 · Sabrina S. Saraiva1 · Laís Q. Tobaldini1 · Ana Paula R. dos Santos1 · Joyce Annichino‑Bizzacchi2 · Fernanda A. Orsi1,3
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The role of inflammation in thrombotic complications of primary antiphospholipid syndrome (PAPS) is controversial. The aim of this study was to evaluate levels of inflammation and coagulation markers in patients with thrombotic PAPS (t-PAPS). Patients with t-PAPS and individuals with no history of thrombosis were enrolled. The association of t-PAPS with levels of tumor necrosis factor (TNF)-α, C-reactive protein (hs-CRP), interferon (IFN)-α, interleukins (IL)-6, -8, factor VIII (FVIII), von Willebrand factor (VWF) and tissue factor (TF) was evaluated by regression models. The levels of these markers were also compared between controls and subgroups of t-PAPS patients with triple positivity, recently diagnosed thrombosis, recurrent thrombosis and venous thrombosis. Patients with t-PAPS (n = 101) had a 8.6-fold increased levels of TNF-α, 90% increased levels of hs-CRP, 80% increased levels of IL-6, 30% increased levels of FVIIIAg, 50% increased levels of VWF and 66% increased levels of TF as compared to controls (n = 131), and the differences did not change after adjustments for sex, age and cardiovascular risk factors. Inflammatory markers were elevated in t-PAPS regardless of the aPL profile, number of previous thrombosis or time elapsed since diagnosis. TNF-α and IL-8 levels were higher in t-PAPS patients with venous thrombosis, in comparison with those with arterial thrombosis and controls. Patients with t-PAPS presented with increased levels of inflammatory and coagulation markers, which suggests that t-PAPS is associated not only with hypercoagulability but also with a persistent inflammatory state. Keywords Antiphospholipid syndrome · Inflammation · Coagulation · Thrombosis
Highlights • Hypercoagulability is present in patients with thrombotic
PAPS. • An inflammatory state is also detected in thrombotic PAPS.
* Fernanda A. Orsi [email protected] 1
School of Medical Sciences, University of Campinas, Campinas, Brazil
2
Department of Clinical Medicine, School of Medical Sciences, University of Campinas, Campinas, Brazil
3
Department of Clinical Pathology, School of Medical Sciences, School of Medical Sciences, University of Campinas, Campinas R. Tessália Vieira de Camargo, 126. Cidade Universitária, Campinas 13083‑887, Brazil
• Inflammation is increased in t-PAPS regardless of the
severity of the disease.
• The role of anti-inflammatory and immunomodulatory
therapies in t-PAPS are yet to be determined.
Introduction Primary antiphospholipid syndrome (PAPS) is a chronic immune-mediated disorder in which antibodies directed to phospholipid-binding proteins trigger a procoagulant and inflammatory state that leads to placental vascular complications and thrombotic events o
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