Antiphospholipid Antibodies and Activated Protein C Resistance in Patients with Leg Ulcers

Kim, Jae Wang; Kim, Su Young; Kim, Kwang Joong; Lee, Chong Ju; Cho, Byoung Geo; Lee, Kwang Hee

Abstract

BACKGROUND: Antiphospholipid antibodies(APA) including anticardiolipin antibodies(ACA) are significantly associated with ulcerations of the leg. Moreover, resistance to activated protein C(aPC) may be an important risk factor in leg ulcerations. Until now, there has been no clinical investigation about the positivity of APA or resistance to aPC in patients with leg ulcers in Korea.
OBJECTIVE
We investigated the positivity to APA and the presence of resistance to aPC in patients with leg ulcers in Korea.
METHODS
Venous or arterial ultrasonic Doppler, semiquantitative assay for serum APA and functional analysis for aPC resistance were conducted in 32 patients with leg ulcers.
RESULTS
1. Of the 32 patients with leg ulcers, 34,3% had a positive APA. APA were more frequently associated with venous ulcerations of the leg than in subjects with leg ulcers of arterial or mixed origin. 2. aPC resistance based upon the functional analysis, occurred in 43.7% to 46.8% of leg ulcer patients. 3. Livedo reticularis (38.1%) and superficial thrombophlebitis (19.0%) were the most common cutaneous manifestations accompanied by leg ulcers in 21 APA-positive and/or aPC resistant patients. Deep vein thrombosis of extremities was the most common complication (47.6%) among the systemic thrombotic sequelaes in APA-positive and/or aPC resistant patients.
CONCLUSION
APA positivity and aPC resistance may be relatively common anticoagulant defects among patients with leg ulcerations in Korea. APA positivity and aPC resistance should be considered important risk factors for the development of not only leg ulcers but also systemic thrornbotic complications.