Antiphosphatidylserine/Prothrombin Antibodies: An Update on Their Association with Clinical Manifestations of Antiphospholipid Syndrome

Abstract

Objective The aim of the study is to perform a systematic review on the recent available evidence on antiphosphatidylserine/prothrombin (aPS/PT) antibodies and their association with clinical manifestations of the antiphospholipid syndrome (APS). Methods A detailed literature search was applied a priori to Ovid MEDLINE, In-Process and Other Non-Indexed Citation 2012 to present and to abstract from EULAR and ACR/ARHP Annual Meetings (2012–2019). Results Data from 2,901 patients, 587 diseases controls and 559 healthy controls included in 15 retrieved studies was analyzed. The patient population included 1,219 patients classified as APS according to the Sidney criteria, 285 patients with isolated persistently positive antiphospholipid antibodies (aPL) and 1,397 patients with a clinical suspicion of APS. Twelve studies, including 1,888 patients, analyzed the association between aPS/PT antibodies and thrombosis. We observed a statistically significant association between aPS/PT IgG/IgM positivity and thrombotic events (mean odds ratio [OR]: 6.8 [95% CI: 3.18–16.4], p < 0.05), confirmed when analyzing aPS/PT IgG (mean OR: 6.7 [95% CI: 3.04–21.6], p < 0.05) and aPS/PT IgM (mean OR: 4.35 [95% CI: 1.54–17.77], p < 0.05) separately. Seven studies, including 1,388 patients, evaluated the association between aPS/PT antibodies and PM. When pooled together, we found a statistically significant association between any PM and aPS/PT IgG/IgM positivity (mean OR: 10.6 [95% CI: 3.54–35.38], p < 0.05), particularly aPS/PT IgG positivity (mean OR: 6.7 [95% CI: 3.04–21.6], p < 0.05). Conclusion Our results highlight the strong association between aPS/PT and the clinical manifestations of APS. With the available level of evidence, aPS/PT testing can be considered as a robust test applicable in the investigation of patients suspected for APS, also beyond the research settings.

The prevalence of antiphospholipid antibodies in women with late pregnancy complications and low‐risk for chromosomal abnormalities

“…Among the extra criteria aPL, testing for aPS/PT antibodies has been proposed as an additional tool to be considered when investigating a patient suspected of having antiphospholipid syndrome, particularly in the absence of routine aPL positivity, 29,30 or as a part of risk assessment strategies. 31 A recent systematic review 32 Our work has some limitations that need to be acknowledged.…”

“…Among the extra criteria aPL, testing for aPS/PT antibodies has been proposed as an additional tool to be considered when investigating a patient suspected of having antiphospholipid syndrome, particularly in the absence of routine aPL positivity, 29,30 or as a part of risk assessment strategies 31 . A recent systematic review 32 that analyzed the studies on aPS/PT and their correlation with clinical manifestations of antiphospholipid syndrome from 2012 to 2019 showed a statistically significant association between any pregnancy morbidity and aPS/PT IgG/IgM positivity (mean OR 10.6 [95% CI 3.54‐35.38], P < .05).…”

Is There an Additional Value in Detecting Anticardiolipin and Anti-β2 glycoprotein I IgA Antibodies in the Antiphospholipid Syndrome?

“…33 A recent systematic review showed a strong association between aPS/PT aPL and clinical manifestations of APS, with a high association with LAC. 34 However, this needs to be validated in a large multicenter study.…”

Non-Criteria Antiphospholipid Antibodies: Risk Factors for Endothelial Dysfunction in Women with Pre-Eclampsia

“…Various studies have demonstrated the clinical utility of aPS/PT in the diagnosis of APS, especially in the absence of antibodies included in the diagnostic criteria [ 15 , 61 , 62 ]. Likewise, several studies have indicated a strong association between aPS/PT antibodies and obstetric morbidity [ 20 , 59 , 63 ]. However, they have not yet been included as classification criteria for APS because some drawbacks in the studies, such as the small size on which these data are based, the methodological differences in their design, the lack of standardization in their determination and the contradictory results related to their association with the APS.…”