Diagnostic biologique du syndrome des antiphospholipides : des critères à la pratique

Joste, Valentin; Dragon-Durey, Marie-Agnès; Darnige, Luc

doi:10.1016/j.revmed.2017.02.006

Cited by 14 publications

(10 citation statements)

References 44 publications

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“…Although the specificity of the aβ2GPI ELISA for the diagnosis of APS is better than that of aCL, since it does not detect aPL present in infections, it remains to mention that this specificity is accompanied by a lower sensitivity. 15 The major problem for the detection of aCL and aβ2GPI lies in the high variability between the tests available to establish the thresholds of antibody positivity. Although the IgG isotype is more correlated with the occurrence of thrombotic events than IgM, however, the role of IgM should be further established, particularly in pregnancy complications' context.…”

Section: Discussionmentioning

confidence: 99%

“…Some patients with purely obstetrical APS present an isolated IgM positivity, hence the importance of researching this isotype. 15 It should be noted that, despite numerous efforts to standardize the detection of aPL by immunological tests, it is still insufficient, given the great inter-method and interlaboratory variability. The application of different polyclonal or monoclonal antibody standards in ELISA kits, combined with manufacturer-specific production techniques, leads to a great inconsistency between methods and consequently an extremely high variability between laboratories and methods, usually exceeding 50%-100%.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, a particular vigilance should be accorded to situations of aCLÀ/ aβ2GPI+ discordance while the aCL kit detects β2GPI-dependent aCL. 15 In our study, three types of antibodies were explored: LAC, aCL, and aβ2GPI. Several pieces of evidence suggest that the aPL profile is linked to thrombotic risk.…”

Section: Discussionmentioning

confidence: 99%

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Antiphospholipid antibodies in the obstetric antiphospholipid syndrome: Detection and antibodies profile at the Maternity and Neonatal Medicine Center of Monastir, Tunisia

Khefacha

Rassas

Bergaoui

et al. 2022

J of Obstet and Gynaecol

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Purpose This study aimed to implement lupus anticoagulant (LAC) detection techniques according to the International Society on Thrombosis and Hemostasis (ISTH) recommendations, in the Biological Laboratory of the Maternity and Neonatal Medicine Center (Monastir, Tunisia) and to evaluate the profile and the prevalence of antiphospholipid antibodies (aPL) in the obstetric antiphospholipid syndrome (OAPS). Methods We collected two groups: a “case group” (53 women who presented one or more obstetrical criteria of APS) and a “control group.” LAC was detected following the four steps recommended by ISTH 2009. Anticardiolipin (aCL) and antibeta‐2‐glycoprotein I (aβ2GPI) antibodies testing were performed by enzyme‐linked immunosorbent assay (ELISA). Results aPL were found in five patients: three patients with isolated LAC, one patient with isolated IgG aCL, and one patient with triple positivity (LAC, aCL IgM, aβ2GPI IgM). Concerning LAC, 13 (24.52%) of 53 patients had a screening step with at least one positive test. The mixing step was positive in four patients and then confirmed in the confirmatory test. Thus, the prevalence of LAC in our study group is 7.54%. Surprisingly, among these positive patients, one patient had an associated combined factor V (FV) and factor VIII (FVIII) deficiency. Conclusion There is no single test and no algorithm that can detect all types of LAC. It seems that the recent 2020 ISTH algorithm allows a better detection of low activity LAC than the 2009 algorithm. In our study, the most frequently identified antiphospholipid antibodies were LAC more than aCL and aβ2GPI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Antiphospholipid antibodies in the obstetric antiphospholipid syndrome: Detection and antibodies profile at the Maternity and Neonatal Medicine Center of Monastir, Tunisia

Khefacha

Rassas

Bergaoui

et al. 2022

J of Obstet and Gynaecol

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“…Since DOACs are increasingly used to treat patients with thrombotic events, and because it is not uncommon to be prescribed prior to aPL diagnosis, accurate aPL testing is mandatory to avoid inappropriately using these anticoagulant compounds in the APS population. The results of detection and quantification of aCL and anti-β 2 GPI antibodies by solid-phase immunoassay are not influenced by the presence of DOACs in plasma or serum samples from patients taking these drugs [ 54 ]; conversely, the presence of DOACs, even at very low concentrations, interferes with LAC testing, which is based on the prolongation of PL-dependent clotting times, mainly inducing false-positive results [ 55 ]. Due to their heterogeneity, LAC testing should be performed using at least two coagulation assays with differing analytical principles, where the first is based on dilute Russell Viper Venom Time (dRVVT), and the second is derived from activated partial thromboplastin time.…”

Section: Aps: Update On Doacs’ Usementioning

confidence: 99%

Recent Advances in Anticoagulant Treatment of Immune Thrombosis: A Focus on Direct Oral Anticoagulants in Heparin-Induced Thrombocytopenia and Anti-Phospholipid Syndrome

Carré

Jourdi

Gendron

et al. 2021

IJMS

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For more than 10 years, direct oral anticoagulants (DOACs) have been increasingly prescribed for the prevention and treatment of thrombotic events. However, their use in immunothrombotic disorders, namely heparin-induced thrombocytopenia (HIT) and antiphospholipid syndrome (APS), is still under investigation. The prothrombotic state resulting from the autoimmune mechanism, multicellular activation, and platelet count decrease, constitutes similarities between HIT and APS. Moreover, they both share the complexity of the biological diagnosis. Current treatment of HIT firstly relies on parenteral non-heparin therapies, but DOACs have been included in American and French guidelines for a few years, providing the advantage of limiting the need for treatment monitoring. In APS, vitamin K antagonists are conversely the main treatment (+/- anti-platelet agents), and the use of DOACs is either subject to precautionary recommendations or is not recommended in severe APS. While some randomized controlled trials have been conducted regarding the use of DOACs in APS, only retrospective studies have examined HIT. In addition, vaccine-induced immune thrombotic thrombocytopenia (VITT) is now a part of immunothrombotic disorders, and guidelines have been created concerning an anticoagulant strategy in this case. This literature review aims to summarize available data on HIT, APS, and VITT treatments and define the use of DOACs in therapeutic strategies.

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“…D'autres manifestations plus rares sont possibles comme une thrombopénie, une atteinte neurologique, rénale, cutanée, valvulaire (endocardite de Libman-Sacks) ou le syndrome catastrophique des antiphospholipides (CAPS) [1]. Aux manifestations cliniques, sont associés un ou plusieurs critères biologiques qui doivent être identifiés à deux reprises espacées d'au minimum 12 semaines d'intervalle pour retenir le diagnostic : anticoagulant circulant de type lupique, anticorps anti-cardiolipine, anticorps anti-β2-glycoprotéine1 [2,3].…”

Section: Introductionunclassified

Une endocardite de Libman-Sacks survenant sous apixaban chez une patiente atteinte de SAPL veineux de profil à haut risque

Allain

Paven

Henriot

et al. 2021

La Revue de Médecine Interne

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Nous rapportons le cas d'une patiente de 63 ans atteinte de sclérose en plaque et d'un syndrome des antiphospholipides ayant présenté une endocardite mitrale de Libman-Sacks compliquée d'accidents vasculaires ischémiques après deux années d'apixaban. La réintroduction de tinzaparine puis de warfarine au long cours et deux mois d'hydroxychloroquine ont permis une amélioration des lésions valvulaires. ConclusionÀ notre connaissance, il s'agit du premier cas d'endocardite de Libman-Sacks survenue sous apixaban pour le traitement d'un syndrome des antiphospholipides. Cette atteinte grave conforte l'idée que les anticoagulants oraux directs ne sont pas à utiliser dans la prévention des évènements thrombotiques au cours du syndrome des antiphospholipides.HTP post-embolique. Dans le contexte, il n'avait pas été réalisé de cathétérisme cardiaque.En 2018, après deux années de traitement par apixaban à dose pleine (5 mg matin et soir), la patiente était hospitalisée pour des troubles du comportement. Elle était apyrétique. L'IRM encéphalique montrait trois lésions ischémiques récentes dans des territoires vasculaires différents. Des lésions de SEP anciennes et actives étaient également visualisées. La ponction lombaire était normale. L'ETT puis l'échographie trans-oesophagienne (ETO) mettaient en évidence une végétation de 22 mm de la valve mitrale, sans fuite valvulaire sévère (Fig. 1) et de discrets éléments vibratiles sur la valve aortique inférieurs à 3 mm et aspécifiques. Une anticoagulation par tinzaparine à dose curative était proposée en relai de l'apixaban associée à l'aspirine 75 mg/j et l'hydroxychloroquine 400 mg/j dans l'hypothèse d'une endocardite de Libman-Sacks. L'aspirine était arrêtée à j10 en raison d'une hémorragie digestive

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Diagnostic biologique du syndrome des antiphospholipides : des critères à la pratique

Cited by 14 publications

References 44 publications

Antiphospholipid antibodies in the obstetric antiphospholipid syndrome: Detection and antibodies profile at the Maternity and Neonatal Medicine Center of Monastir, Tunisia

Antiphospholipid antibodies in the obstetric antiphospholipid syndrome: Detection and antibodies profile at the Maternity and Neonatal Medicine Center of Monastir, Tunisia

Recent Advances in Anticoagulant Treatment of Immune Thrombosis: A Focus on Direct Oral Anticoagulants in Heparin-Induced Thrombocytopenia and Anti-Phospholipid Syndrome

Une endocardite de Libman-Sacks survenant sous apixaban chez une patiente atteinte de SAPL veineux de profil à haut risque

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