Premium
Association of Pulmonary Hemorrhage, Positive Proteinase 3, and Urinary Red Blood Cell Casts With Venous Thromboembolism in Antineutrophil Cytoplasmic Antibody–Associated Vasculitis
Author(s) -
Kronbichler Andreas,
Leierer Johannes,
Shin Jae Il,
Merkel Peter A.,
Spiera Robert,
Seo Philip,
Langford Carol A.,
Hoffman Gary S.,
Kallenberg Cees G. M.,
St.Clair E. William,
Brunetta Paul,
Fervenza Fernando C.,
Geetha Duvuru,
Keogh Karina A.,
Monach Paul A.,
Ytterberg Steven R.,
Mayer Gert,
Specks Ulrich,
Stone John H.
Publication year - 2019
Publication title -
arthritis and rheumatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.106
H-Index - 314
eISSN - 2326-5205
pISSN - 2326-5191
DOI - 10.1002/art.41017
Subject(s) - medicine , vasculitis , hazard ratio , gastroenterology , confidence interval , univariate analysis , urinary system , anti neutrophil cytoplasmic antibody , multivariate analysis , surgery , disease
Objective To assess the frequency of venous thromboembolism ( VTE ) events in the Rituximab in Antineutrophil Cytoplasmic Antibody ( ANCA )–Associated Vasculitis ( RAVE ) trial and identify novel potential risk factors. Methods VTE events in 197 patients enrolled in the RAVE trial were analyzed. Baseline demographic and clinical characteristics were recorded, and univariate and multivariate analyses were performed to identify factors associated with VTE in ANCA ‐associated vasculitis ( AAV ). Results VTE occurred in 16 patients (8.1%) with an overall average time to event of 1.5 months (range 1.0–2.75). In univariate analyses with calculation of hazard ratios ( HR s) and 95% confidence intervals (95% CI s), heart involvement ( HR 17.408 [95% CI 2.247–134.842]; P = 0.006), positive proteinase 3 ( PR 3)– ANCA ( HR 7.731 [95% CI 1.021–58.545]; P = 0.048), pulmonary hemorrhage ( HR 3.889 [95% CI 1.448–10.448]; P = 0.008), and the presence of red blood cell casts ( HR 15.617 [95% CI 3.491–69.854]; P < 0.001) were associated with the onset of VTE . In multivariate models adjusted for age and sex, the significant associations between VTE events and heart involvement ( HR 21.836 [95% CI 2.566–185.805]; P = 0.005), PR 3‐ ANCA ( HR 9.12 [95% CI 1.158–71.839]; P = 0.036), pulmonary hemorrhage ( HR 3.91 [95% CI 1.453–10.522]; P = 0.007), and urinary red blood cell casts ( HR 16.455 [95% CI 3.607–75.075]; P < 0.001) remained. Conclusion Patients diagnosed as having AAV with pulmonary hemorrhage, positive PR 3‐ ANCA , heart involvement, and the presence of red blood cell casts are at an increased risk to develop VTE . 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.