Current status and role of antiphospholipid antibody testing in cryptogenic stroke

Abstract

Background and purpose Although it is not recognized as essential to test for antiphospholipid antibody (aPL) in stroke of unknown cause, aPL‐related stroke may account for a considerable number of cryptogenic strokes. We aimed to assess the current status and diagnostic value of aPL testing in cryptogenic stroke patients. Methods Consecutive patients admitted with acute ischemic stroke were examined to confirm the factors associated with performing aPL testing and with positive aPL test results in real‐world practice. Cryptogenic stroke patients were separately examined in the same manner. The antibody profiles of cryptogenic stroke patients with aPL positivity were compared by age. Results Among 2947 patients, 606 (20.6%) were tested for aPLs and 129 (21.3%) were positive. Physicians tended to perform aPL testing in patients aged <50 years and in cryptogenic stroke patients. Cryptogenic stroke was a strong predictor of positive aPL results (adjusted odds ratio 3.70, 95% confidence interval 2.38–5.76). However, aPL positivity did not differ by age in stroke patients. Among 283 cryptogenic stroke patients, 136 (48.1%) were tested for aPLs and 56 (41.2%) were positive. aPL tests were performed predominantly in patients aged <50 years rather than in older patients, even among cryptogenic stroke patients. The two age groups had similar positivity rates of >40% (<50 years: 43.2%; ≥50 years: 40.4%; p = 0.92) and their antibody profiles were similar. Conclusions A significant number of patients with cryptogenic stroke had positive aPL results regardless of age. aPL testing may offer additional diagnostic opportunities in cryptogenic stroke patients, and thus may reduce the incidence of cryptogenic stroke.

Neurovascular Issues in Antiphospholipid Syndrome: Arterial Vasculopathy from Small to Large Vessels in a Neuroradiological Perspective

“…From a neurologist's perspective, understanding the distinct characteristics of aPLstroke holds potential in mitigating cryptogenic stroke cases, in particular in comparison with occult atrial fibrillation (AF) -associated cryptogenic stroke. In this subset of patients with cryptogenic stroke, a notably high aPL-positivity rate was reported across all age groups [127]. Distinguishing features of aPL-stroke from AF-related stroke (AF-stroke) could streamline aPL screening in such cases, thereby reducing diagnostic ambiguity.…”

A Cryptogenic Stroke Associated With Infective Endocarditis and Antiphospholipid Antibody Syndrome: Case Report and Literature Review

“…Cardiac embolism due to IE is an extraordinary stroke etiology, accounting for nearly 30% of all patients with IE ( 7 ). Non-infective endocarditis can complicate APS, which is a systemic autoimmune disease characterized by thrombotic complications in patients positive for aPL ( 5 , 8 , 9 ). The APS-associated non-infective endocarditis was reported to be Libman–Sacks (LS) endocarditis ( 10 ).…”

Neuroimaging features of antiphospholipid antibody-related stroke compared with atrial fibrillation-related stroke

“…However, the underlying etiologies of cryptogenic stroke can be diverse, and aPL-stroke may also be an underestimated cause. From this point of view, we recently reported a high aPL positivity rate in patients with cryptogenic stroke regardless of age 6 . Identifying distinct features of aPL-stroke compared with AF-related stroke (AF-stroke), the most clinically important cause of cryptogenic stroke, may provide guidance for efficient aPL screening in cryptogenic stroke and subsequently contribute to reduced diagnostic uncertainty.…”