Sex Differences in Clinical Characteristics and Prognosis in Primary Thrombotic Antiphospholipid Syndrome

Abstract

ObjectivesThis study aimed to investigate whether there are sex differences in clinical characteristics and prognosis in patients with primary thrombotic antiphospholipid syndrome (ptAPS).MethodsFrom January 2013 to July 2021, 154 consecutive patients diagnosed with ptAPS were prospectively recruited. Multivariable Cox regression was used to evaluate the association between gender and the composite endpoint including thromboembolic recurrence or all-cause death during follow-up.ResultsTotally, 80 (52%) male and 74 (48%) female patients with ptAPS were included, and men had a higher percentage of smokers/ex-smokers [50 (62%) vs. 6 (8%), p < 0.001] and hyperhomocysteinemia [26 (32%) vs. 9 (12%), p = 0.003]. The baseline thromboembolic events were similar in two genders, except for limb ischemia [15 (19%) in men vs. 1 (1%) in women, p < 0.001]. During a median follow-up of 42 months, the composite endpoint occurred in 30 (38%) male and 15 (20%) female patients (p = 0.019). Male gender [HR 2.499, 95% CI (1.316, 4.743), p = 0.005] and warfarin administration [HR 0.482, 95% CI (0.257, 0.905), p = 0.023] remained independent risk factors for the composite endpoint. Male gender [HR 3.699, 95% CI (1.699, 8.246), p = 0.001] and isolated lupus anticoagulant positivity [HR 2.236, 95% CI (1.039, 4.811), p = 0.040] were independent risk factors for thromboembolic recurrence.ConclusionThere are sex disparities in the clinical characteristics in patients with ptAPS and the male gender is an independent risk factor for the poor prognosis. Male patients with isolated lupus anticoagulant (LA) positivity have the highest risk of thromboembolic recurrence.

Risk Factors for Antiphospholipid Antibodies and Antiphospholipid Syndrome

“…In spite of females making up the majority of APS patients (mostly due to its association with SLE and obstetric events), male patients have an increased risk of thrombosis and thrombosis recurrence compared to females in most studies. 26,54,55 Age Some studies, including a systematic review of 43 studies with stroke related to APS, showed that aPL may have a big role in strokes in younger patients. Individuals younger than 50 years and positive aPL have an increased risk for thrombotic cerebrovascular events by almost sixfold compared to those younger than 50 years and negative aPL.…”

“…In spite of females making up the majority of APS patients (mostly due to its association with SLE and obstetric events), male patients have an increased risk of thrombosis and thrombosis recurrence compared to females in most studies. 26 54 55…”