Diagnostic and Prognostic Significance of Anticardiolipin Antibodies in Patients With Recurrent Spontaneous Abortions

Melk, Anette; Mueller‐Eckhardt, G.; Polten, Barbara; Lattermann, A.; Heine, O.; Hoffmann, Oliver

doi:10.1111/j.1600-0897.1995.tb00889.x

Cited by 19 publications

(4 citation statements)

References 19 publications

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“…Although LAC showed a high positive predictive value for the presence of clinical features of APS, it was less sensitive in comparison with the IgG isotype of aCL. The present study also showed the highest clinical accuracy of GPL that is in agreement with several earlier studies [28,30,[34][35][36].…”

Section: Discussionsupporting

confidence: 81%

Evaluation of the Different Antiphospholipid Antibodies for the Diagnosis of Antiphospholipid Syndrome

Kaushik

Malaviya²,

Al-Attiya³

et al. 1999

Med Princ Pract

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Objective: Antiphospholipid syndrome (APS) or Hughes syndrome is a frequently seen condition in Kuwait that is characterised by the presence of significant titres of a variety of antiphospholipid antibodies (aPL). The main clinical features of this syndrome include thrombosis (both venous and arterial), recurrent fetal wastage and thrombocytopenia. The aim of the present study was to find out the antibodies with a high predictive value for the diagnosis of APS. Methodology: The study included a total of 38 subjects. Nine of them were patients with proven primary APS, 10 with secondary APS and 19 were patients (controls) with weak clinical evidence of APS. After a complete clinical examination and routine investigations, the following categories of aPL were estimated by standard laboratory techniques: anticardiolipin antibodies of IgG and IgM isotypes (GPL and MPL, respectively), anti-ß 2 -glycoprotein-I antibodies (anti-ß 2 -GPI) of IgG and IgM isotypes and activated partial thromboplastin time as a surrogate for lupus anticoagulant (LAC). The tests were considered positive if the titres were more than a standard cut-off value provided by the manufacturer of the kits, and in one instance, the normal range was established in our laboratory (LAC). Results: The highest sensitivity (78.9%) and diagnostic accuracy (71.1%) were obtained by the estimation of GPL. However, excellent specificity (100%) and positive predictive value (100%) with almost as good a diagnostic accuracy (68.4%) were also obtained with anti-ß 2 -GPI of IgG isotype. All the other tests performed poorly when compared with these two. There was no difference in the performance of these tests between primary and secondary APS. Conclusion: Of the various aPL estimated, GPL and anti-ß 2 -GPI of IgG isotype were statistically sensitive and specific investigations for confirming the diagnosis of APS.

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Section: Discussionsupporting

confidence: 81%

Evaluation of the Different Antiphospholipid Antibodies for the Diagnosis of Antiphospholipid Syndrome

Kaushik

Malaviya²,

Al-Attiya³

et al. 1999

Med Princ Pract

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“…Nevertheless, these criteria are still not widely applied, which makes it extremely difficult to compare the aPL prevalences between studies. Furthermore, the moment that the test is executed (during pregnancy or after miscarriage) may influence the results as well [21,113].…”

Section: Test Methods For Thrombophiliasmentioning

confidence: 99%

Thrombophilias and recurrent pregnancy loss: a critical appraisal of the literature

Krabbendam

Franx

Bots

et al. 2005

European Journal of Obstetrics & Gynecology and Reproductiv

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“…APL antibodies are a common finding in patients with recurrent fetal loss(es) [65][66][67][68][69][70][71]. Moreover, data show that the concerning the induction of aCL by sex hormones in normal subjects are scarce.…”

Section: Recurrent Fetal Lossmentioning

confidence: 99%

Some Recent Insights into the Prothrombogenic Mechanisms of Antiphospholipid Antibodies

Todorova¹,

Baleva

2007

CMC

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Antiphospholipid antibodies (aPL) are a heterogeneous group of autoantibodies, detected in the sera of patients with both autoimmune and various non-autoimmune diseases. They are also detected in subjects with no overt underlying disease - the primary antiphosphilipid syndrome (PAPS). High titers of APL are associated with arterial and venous thrombosis, recurrent fetal loss and thrombocytopenia. There have been many suggestions explaining the potential mechanisms of the procoagulant effect of aPL. These include endothelial cell (EC) activation; increased adhesion molecule expression; inhibition of EC prostacyclin release, increased leucocyte adhesion to EC, downregulation of thrombomodulin expression. APL induce the procoagulant activity of monocytes via increased tissue factor expression and directly stimulate platelet hyperactivity with resultant production of enhanced amounts of the proaggregatory molecule of TXA(2). In vitro studies show that prepro-endothelin-1 mRNA is induced by human monoclonal anticardiolipin antibodies and this might contribute to vasospasm, and, ultimately, to arterial occlusion. The hypercoagulable state in APS patients is associated with alterations in the protein C/S pathway. It is suggested that aPL may impair the protein C anticoagulant system. Acquired protein C and protein S deficiency is described in patients with APS. Beta2- glycoprotein I, (Beta2-GPI) a natural anticoagulant, is involved in the regulation of protein S anticoagulant activity by preventing the binding of protein S to C4b-binding protein. APL were shown to inhibit this effect of Beta2- GP I. As the group of aPL is very heterogeneous, it is unlikely that a single mechanism is responsible for the thrombogenic activity of all aPLs associated with thrombosis.

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Diagnostic and Prognostic Significance of Anticardiolipin Antibodies in Patients With Recurrent Spontaneous Abortions

Abstract: Although the data from nonpregnant RSA patients does not allow diagnostic or prognostic conclusions to be drawn, sequential testing of ACA-positive individuals provides the possibility to foresee pregnancy outcome.

Cited by 19 publications

References 19 publications

Evaluation of the Different Antiphospholipid Antibodies for the Diagnosis of Antiphospholipid Syndrome

Evaluation of the Different Antiphospholipid Antibodies for the Diagnosis of Antiphospholipid Syndrome

Thrombophilias and recurrent pregnancy loss: a critical appraisal of the literature

Some Recent Insights into the Prothrombogenic Mechanisms of Antiphospholipid Antibodies

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