ANTIPHOSPHOLIPID ANTIBODIES IN VASCULAR-SURGERY PATIENTS - A CROSS-SECTIONAL STUDY

Background Autoantibodies to phospholipid (aPL) have been associated w ith vascular thromboses in cerebral, coronary, and peripheral venous a nd arterial sites. To date, no large cross-sectional study has examine d the incidence of occurrence of aPL in patients with peripheral arter ial disease. Methods A cross-sectional study was performed with patien ts admitted for vascular surgery procedures to treat peripheral arteri al disease for 23 months between January 1, 1990 and November 1, 1991. Consecutive patients were evaluated for the presence of aPL. Medical records for each patient were reviewed in detail, and historic, operat ive, and postoperative parameters were tabulated for relationship to t he presence of aPL. Results Two hundred thirty-four patients underwent complete testing for aPL. All patients were receiving chronic aspirin therapy. This represented 86% of admissions. Antiphospholipid antibod ies were detected in 60 patients (26%). No differences in age, sex, op eration performed, or postoperative outcome were found between patient s with and without aPL. However, patients with aPL were 1.8 times more likely to have undergone previous lower extremity (LE) vascular surge ry than patients without aPL (95% confidence interval = 1.0 - 3.6, p = 0.047). Patients with aPL and previous LE vascular surgery were 5.6 t imes more likely to have had occlusion of that procedure than patients without aPL (95% confidence interval = 1.9 - 16.8, p = 0.03). The occ luded previous LE procedures had a shorter duration of patency before occlusion in patients with aPL than in those without (mean duration of patency 17 months vs. 50 months, p < 0.003). Patients with occluded p revious LE procedures and aPL were 4 times more likely to be female (9 5% C. I. = 1.4 - 11.3, p = 0.018). Conclusions The incidence of aPL in vascular surgery patients is substantial. Vascular surgery patients w ith aPL are more likely to have failure of previous LE bypass procedur es and to be female and the bypass failure occurs significantly more r apidly than in patients without aPL. Based on these data, testing of v ascular surgery patients for aPL and investigation of alternative anti thrombotic treatment regimens in patients with aPL appears warranted.