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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 . . . [Full Text of this Article]

Khaled M. Musallam, BSc; Imad Uthman, MD, MPH; Ali T. Taher, MD
ataher@aub.edu.lb
Department of Internal Medicine
American University of Beirut Medical Center
Beirut, Lebanon

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Microalbuminuria and Risk of Venous Thromboembolism
Bakhtawar K. Mahmoodi, Ron T. Gansevoort, Nic J. G. M. Veeger, Abigail G. Matthews, Gerjan Navis, Hans L. Hillege, Jan van der Meer, and for the Prevention of Renal and Vascular End-stage Disease (PREVEND) Study Group
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