1. Association of Pulmonary Hemorrhage, Positive Proteinase 3, and Urinary Red Blood Cell Casts With Venous Thromboembolism in Antineutrophil Cytoplasmic Antibody–Associated Vasculitis.
- Author
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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, and Stone, John H.
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AUTOIMMUNE disease diagnosis , *HEMORRHAGE complications , *THROMBOEMBOLISM risk factors , *RITUXIMAB , *ERYTHROCYTES , *AGE distribution , *AUTOIMMUNE diseases , *CONFIDENCE intervals , *HEART , *HEMATURIA , *LUNG diseases , *MULTIVARIATE analysis , *PROTEOLYTIC enzymes , *RISK assessment , *SEX distribution , *STATISTICS , *URINALYSIS , *VASCULITIS , *VEINS , *TREATMENT effectiveness , *DISEASE duration , *ODDS ratio , *ANTINEUTROPHIL cytoplasmic antibodies , *DISEASE complications - Abstract
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 (HRs) and 95% confidence intervals (95% CIs), heart involvement (HR 17.408 [95% CI 2.247–134.842]; P = 0.006), positive proteinase 3 (PR3)–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), PR3‐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 PR3‐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. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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