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Arthritis Rheumatol. 2019 Jun 19. doi: 10.1002/art.41017. [Epub ahead of print]

The Association of Pulmonary Haemorrhage, Positive PR3-ANCA and Urinary Red Blood Cell Casts with Venous Thromboembolism in ANCA-Associated Vasculitis.

Author information

1
Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria.
2
Department of Pediatric Nephrology, Institute of Kidney Disease Research, Severance Children's Hospital, Seoul, South Korea.
3
Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital, Seoul, Korea.
4
Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
5
Rheumatology Division, Hospital for Special Surgery, New York, New York, USA.
6
Division of Nephrology and Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA.
7
Center for Vasculitis Care and Research, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
8
Department of Rheumatology and Clinical, Immunology University Medical Center, Groningen, The Netherlands.
9
Division of Rheumatology and Immunology, Duke University, Durham, North Carolina, USA.
10
Genentech, Inc., South San Francisco, California, USA.
11
Division of Pulmonary and Critical Care Medicine and Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
12
Section of Rheumatology, Department of Medicine, Boston University School of Medicine, MA, USA.
13
Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

Abstract

OBJECTIVES:

We aimed to assess the frequency of venous thromboembolic events (VTEs) observed in the Rituximab in ANCA-Associated Vasculitis (RAVE) trial and identify novel potential risk factors.

METHODS:

VTEs in 197 patients enrolled in the RAVE trial were analysed. Baseline demographics, univariate and multivariate analyses were performed to identify factors associated with VTE in ANCA-associated vasculitis.

RESULTS:

VTEs occurred in 16 (8.1%) patients with an overall time to event of 1.5 (range: 1.0-2.75) months. Univariate analyses identified heart involvement (HR 17.408, 95% CI 2.247-134.842), a positive test for proteinase 3 (PR3)-ANCA (HR 7.731, 95% CI 1.021-58.545), pulmonary haemorrhage (HR 3.889, 95% CI 1.448-10.448) and presence of red blood cell casts (HR 15.617 (3.491-69.854) as associated with the onset of VTE. In multivariate models, each adjusted for age and sex, the associations between heart involvement (HR 21.836, 95% CI 2.566-185.805), positive PR3-ANCA (HR 9.12, 95% CI 1.158-71.839, p=0.036), pulmonary haemorrhage (HR 3.910, 95% CI 1.453-10.522) and urinary red blood cell casts (16.455, 95% CI 3.607-75.075) remained significant.

CONCLUSION:

Patients with ANCA-associated vasculitis with pulmonary haemorrhage, positive PR3-ANCA, heart involvement and presence of red blood cell casts are at an increased risk to develop VTEs. Further studies are needed to confirm and expand these findings and to explore the mechanisms of hypercoagulability in these patients with the aim of informing potential targets for therapeutic intervention. This article is protected by copyright. All rights reserved.

KEYWORDS:

ANCA ; PR3; pulmonary haemorrhage; thrombosis; vasculitis

PMID:
31216123
DOI:
10.1002/art.41017

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