PB0039 - Long term follow-up of cerebral magnetic resonance imaging in patients with antiphospholipid syndrome assessing the risk factors for recurrent cerebral events

Background: Cerebral ischaemia is the most common type of arterial disease in antiphospholipid syndrome (APS). Specific risk factors for progression are poorly recognised and optimal antithrombotic treatment is unclear.

Aims: To evaluate cerebral ischaemia in APS patients who had cerebral symptoms and had an MRI scan, risk factors for progression and outcomes of different antithrombotics.

Methods: Electronic records of patients with APS and ≥2 cerebral magnetic resonance imaging (MRI) between 1/9/2012-1/9/2022 from a single tertiary centre were reviewed retrospectively.

Results: 309 MRI scans were identified for 120 patients (median 2 scans/patient). Mean age was 51.3(IQR 42.0-60.2) years at initial MRI, median imaging follow-up 3.6 ±2.4 years, female/male 100/20, mean BMI 31.9kg/m2(IQR 27.1-34.7, n=42). 75.8%(91/120) had ischaemic lesions on initial MRI: white matter lesion(WML) 45.0%(54/120), lacunar infarcts 25.0%(30/120), non-lacunar infarcts 5.8%(7/120). 22.5%(27/120) developed progressive ischaemia on interval MRI(Figure 1). The types of progression were: WML 77.8%(21/27), lacunar infarcts 22.2%(6/27) and non-lacunar infarcts 0%.

Patients with progressive ischaemia (27/120) had a longer follow-up duration(4.7 vs. 3.3 years, p=0.03) and more patients had a history of hypertension(51.9%, 14/27 vs. 28.0% 26/93, p=0.02) compared to those without. No differences were observed in age, BMI, baseline ischaemia, antiphospholipid antibody phenotype including triple positivity, cardiovascular risk factors including hypercholesterolaemia, smoking and diabetes, systemic lupus erythematous (SLE), or antithrombotics.

There was no difference in progression with high-intensity VKA (target INR 3-4) compared to low-intensity VKA (target INR 2-3) (22.6%, 14/62 high-intensity; 23.5%, 4/17 low intensity; p>0.99) with or without antiplatelets. Bleeding was similar between both anticoagulation targets(29.0%, 18/62 high-intensity;29.4%, 5/17 low-intensity; p=0.98).

Conclusion(s): Progressive cerebral ischaemia were seen in a quarter of patients with APS on sequential cerebral MRIs despite antithrombotics; in a cohort predominantly given high-intensity VKA. Duration of follow-up and hypertension appear to be risk factors associated with ischaemic progression with a predominance for small vessel disease.