To the Editor: The cohort study by Dr Mahmoodi and colleagues1 concluded that microalbuminuria is an independent risk factor for venous thromboembolism (VTE). Although the authors described several limitations to their work, they did not consider an important issue. Multivariable analysis controlled for the most common VTE risk factors that may confound the association between microalbuminuria and VTE. However, a diagnosis of antiphospholipid syndrome (APS) or high titers of antiphospholipid antibodies (aPLs) in the study population was not evaluated. We believe this is crucial.
One of the most commonly reported and characteristic renal manifestations of APS is thrombotic microangiopathy, which is characterized by the presence of distinctive microscopic and ultrastructural changes. The most common presenting clinical features of thrombotic microangiopathy include microalbuminuria.2 Moreover, APS has been described as one of the more common acquired causes of venous thrombophilia. Approximately 20% of patients with deep vein thrombosis or pulmonary embolism have high levels of aPLs before the thrombotic event, and about one-third of patients with APS present with VTE.3
In addition, the study population was from the Netherlands. European countries registered in the Euro-Phospholipid project had among the highest incidences of deep vein thrombosis (38.9%) and pulmonary embolism (14.1%) reported in patients with APS.4 The total number of patients with VTE in the study by Mahmoodi et al was 129. Nine patients (14%) had other acquired risk factors, and 66 (51%) had unprovoked VTE. Unless aPL levels were measured, a possible diagnosis of APS cannot be excluded in these 2 subgroups of patients.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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