Journal Article

AB0844 ARTERIAL ISCHEMIC EVENTS AND VENOUS THROMBOSIS IN SYSTEMIC SCLEROSIS: DATA FROM A MONO-CENTRIC STUDY

Fain, O., Mekinian, A., Dellal, A.

2023

Overview

Systemic sclerosis is a systemic autoimmune disease characterized by vasculopathy (Raynaud phenomena), pulmonary arterial hypertension (PAH), and renal crisis), fibrosis of skin and visceral organs (notably the gut, heart, and lungs), and musculoskeletal inflammation (joints, muscles, and tendons) [1]. Inflammation drives atherosclerosis and contributes to cardiovascular (CV) disease [2]. A few studies have examined the incidence of individual macrovascular manifestations such as myocardial infarction, stroke, peripheral artery disease, and venous thromboembolism [3-4-5]. Our aim to estimate the incidence and the arterial ischemic events and venous thrombosis rates of SSc in our database. We also investigated underlying the classical risk factors for venous thromboembolism (VTE) unprovoked (deep venous thrombosis and pulmonary emboli not associated with cancer, recent surgery, hospitalization, fracture and pregnancy) and ASCVD (myocardial infarction and stroke). In a retrospective cohort of SSc patients between 2005 and 2017, arterial ischemic events (myocardial infarction, ischemic stroke), venous thrombosis, risk Factor (Hyperlipidemia, Smoking, Diabetes, hypertension, abdominal obesity), classical risk factors for venous thromboembolism, as well as cardiac, cutaneous and immunological characteristics were assessed. The study population comprised 212 patients (86 % female) with a diagnosis of SSc. We identified a total of 7 (3%) and 26 (12%) patients have respectively an only arterial ischemic events or venous thrombosis, and 6 (3%) additional patients have both arterial and venous thrombosis, with an event during median 10(5-34) and 6 (0-55) years of follow-up. Venous thrombosis (VT) is present in 26 patients (12 %), active or historic neoplasia is present in 4 patients (15%) of VT. In comparison of patient without VT, 20 patients (11%) have a neoplasia. Arterial ischemic events are also most frequent in female sex n=6 (86 %) with all patients (100%) have a limited sclerosis, antinuclear antibodies and Raynaud phenomena, but no difference with the control group without thrombotic events. The prevalence of most cardiovascular disorders was found to be higher in the SSc with limited sclerosis than in diffuse sclerosis. The tobacco use, alcohol is not associated of increase risk of thromboembolic events. The presence of other autoimmune tissue disorders is not significant (p>0.0003) associated of increase rate among patients with SSc with thrombotic events than without. Further adjustment for medications (aspirin, NSAIDs, glucocorticoids, statins, oral anticoagulants, and platelet inhibitors) and comorbidities yielded results similar to the main analyses, except for ischemic stroke. In this monocentric study, SSc was associated with greater risks of venous thrombosis and ischemic events, with a mortality rate in group with arterial ischemic events. There is no significant statistic difference associated of the classical risk factors of venous thromboembolism, comorbidity and the arterial ischemic events and venous thrombosis in systemic sclerosis. [1]Clements PJ, Hurwitz EL, Wong WK, et al. Skin thickness score as a predictor and correlate of outcome in systemic sclerosis. Arthritis Rheum. 2000; 43:2445–2454 [2]Wollheim FA. Classification of systemic sclerosis. Visions and reality Rheumatology. 2005;44:1212–6. [3]Ranque B, Mouthon L. Geoepidemiology of systemic sclerosis. Autoimmun Rev. 2010;9: A311–8 [4]Singer DE, Albers GW, Dalen JE, et al. Antithrombotic therapy in atrial Fibrillation. American College of Chest Physicians evidence-based clinical practice guidelines (8th edition) Chest. 2008;133(6 Suppl):546S–592S [5]Becker RC, Meade TW, Berger PB, et al. The primary and secondary prevention of coronary artery disease. American College of Chest Physicians evidence-based clinical practice guidelines (8th edition) Chest. 2008;133(6 Suppl):776S–814S NIL. None Declared.

• Publisher: Elsevier B.V,Elsevier Limited
• Subject: Antinuclear antibodies / Arteriosclerosis / Aspirin / Autoimmune diseases / Cardiovascular disease / Cerebral infarction / Chest / Clinical medicine / Clinical practice guidelines / Comorbidities / Diabetes mellitus / Fibrosis / Heart attacks / Heart diseases / Hyperlipidemia / Hypertension / Inflammation / Ischemia / Joint diseases / Muscles / Myocardial infarction / Patients / Population studies / Risk factors / Scleroderma / Statins / Stroke / Systemic sclerosis / Tendons / Thromboembolism / Thrombosis / Vascular diseases / Vein & artery diseases