Assessment of Major Adverse Cardiovascular Events and Thrombotic Risk for Patients with Rheumatic Disease
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Abstract
Background: Patients with rheumatic disease are at increased risk for thrombotic events and MACE due to systemic inflammation. Bleeding time is a test performed in the clinic and consistently confirms a short time to clot with known risk factors such as estrogen, cox-2 inhibitors, JAK inhibitors, and factor V Leiden. We explored whether patients with rheumatic disease have a short bleeding time.
Methods: All sequential 239 patients over age 50 with rheumatic disease had a bleeding time test (BT). Data was collected between 2022- 2024. Patients began low dose aspirin 81 mg daily in 2023 had a repeat BT. No patients had a history of cardiovascular disease. For those with MACE or a thrombotic event BT at baseline (prior to the event) and BT after the event were compared. Cohorts were analyzed by assigned treatments for rheumatic disease including methotrexate, JAK inhibitors, TNF inhibitors, abatacept, secukinumab, IL-1 inhibitors, and PD-1 agonist.
Results: Rheumatic disease patients at baseline had shorter BT results compared to historical normal controls (1.52 + 0.77) versus 4-7 minutes found in the normal general population (p<0.01). There was no difference in the short BT among patients with rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, or lupus. Cohorts analyzed by treatment found BT was similarly short with each. The addition of low dose aspirin 81 mg daily dramatically raised BT nearly double. There were 15 who developed MACE or a thrombotic event prior to aspirin therapy, and death resulted for three patients. These patients all had short BT test results but did not differ from those who did not have a clotting event. The only significant findings in the MACE/thrombotic group was older age by almost a decade, predominantly male gender, and 80% were smokers.
Conclusion: All patients with rheumatic disease had short BT results. BT did not identify a specific individual who would develop MACE or a thrombotic event. BT tests did revert to normal with low dose aspirin 81 mg daily. Aspirin is now recommended prophylactically in all lupus with phospholipid syndrome. Perhaps it is time to consider low dose aspirin for patients over age 50 with rheumatic disease.
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