Laboratory criteria for antiphospholipid syndrome: communication from the SSC of the ISTH

Devreese, Katrien; Ortel, Thomas L.; Pengo, Vittorio; Laat, Bas de

doi:10.1111/jth.13976

Cited by 216 publications

(232 citation statements)

References 51 publications

(92 reference statements)

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“…) . We accept that the cut‐off calculated by the 99th percentile of a normal population is the best consensus between sensitivity and specificity, and the clinical relevance of aCL and/or a β 2GPI results that are below the 99th percentile needs to be further studied . Few studies showed that low titers of aCL also were predictive for thrombotic recurrence .…”

Section: Discussionmentioning

confidence: 99%

Identification of high thrombotic risk triple‐positive antiphospholipid syndrome patients is dependent on anti‐cardiolipin and anti‐β2glycoprotein I antibody detection assays

Chayouâ

Kelchtermans

Moore

et al. 2018

Journal of Thrombosis and Haemostasis

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Background The antiphospholipid syndrome (APS) is characterized by thrombosis and/or pregnancy morbidity with the persistent presence of antiphospholipid antibodies (aPL). Triple-positivity (i.e. positivity for lupus anticoagulant [LAC], anti-cardiolipin [aCL] and anti-β2glycoprotein I [aβ2GPI] antibodies) is associated with a high thrombotic risk. Objectives We investigated the variability in triple-positivity detection by measuring the same samples with four commercially available solid phase assays. In addition, the added clinical value of aPL in LAC-positive patients was investigated, as well as the association of IgM triple-positivity and thrombosis. Patients/Methods We included 851 patients from seven European medical centers. Anti-CL and aβ2GPI IgG/IgM antibodies were determined by four platforms: BioPlex 2200, ImmunoCap EliA, ACL AcuStar and QUANTA Lite ELISA . Results Triple-positivity detection by solid phase assays varied, ranging from 89 up to 118 in thrombotic APS patients (n = 258), of which 86 were detected independent of the platform. Lupus anticoagulant positivity resulted in an odds ratio (OR) for thrombosis of 3.4; triple-positivity (irrespective of the isotype) increased the OR from 4.3 up to 5.2, dependent on the platform. Triple-positivity solely for the IgM isotype did not increase the OR for thrombosis compared with LAC positivity. The highest OR for thrombosis was reached for positivity for IgG and IgM aβ2GPI and aCL (8.6 up to 28.9). Conclusions Triple-positivity proved to be highly associated with thrombosis, but identification is assay dependent. Within triple-positivity, IgM antibodies only have an added clinical value in patients positive for IgG antibodies.

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Section: Discussionmentioning

confidence: 99%

Identification of high thrombotic risk triple‐positive antiphospholipid syndrome patients is dependent on anti‐cardiolipin and anti‐β2glycoprotein I antibody detection assays

Chayouâ

Kelchtermans

Moore

et al. 2018

Journal of Thrombosis and Haemostasis

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“…Beyond the examples listed in table 11, patients who are carriers of some forms of hereditary thrombophilia, notably those with confirmed deficiency of antithrombin, protein C, or protein S, and patients with homozygous factor V Leiden or homozygous prothrombin G20210A mutation, are often candidates for indefinite anticoagulant treatment after a first episode of PE occurring in the absence of a major reversible risk factor. In view of these possible implications, testing for thrombophilia (including antiphospholipid antibodies and lupus anticoagulant) [342] may be considered in patients in whom VTE occurs at a young age (e.g. aged <50 years) and in the absence of an otherwise identifiable risk factor, especially when this occurs against the background of a strong family history of VTE.…”

Section: Assessment Of Venous Thromboembolism Recurrence Riskmentioning

confidence: 99%

2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)

et al. 2019

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“…First, although some of the studies describe outcomes in patients with a diagnosis of APS based on published classification criteria, 1,24 other studies describe patients with an initial VTE or ATE who test positive for the presence of aPL (Table 1). Because most of the latter studies performed a single test for aPL, they would not meet current classification criteria for a diagnosis of APS 1,24 or current recommendations for aPL testing 48 . However, we elected to include these studies because the presence of a thromboembolic event and an aPL are two diagnostic criteria for APS.…”

Section: Discussionmentioning

confidence: 99%

Recurrent thrombosis in patients with antiphospholipid antibodies and an initial venous or arterial thromboembolic event: A systematic review and meta‐analysis

Ortel

Meleth

Catellier

et al. 2020

Journal of Thrombosis and Haemostasis

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Background Patients with antiphospholipid antibodies (aPL) and thromboembolism (TE) are at risk for recurrent TE. Few studies, however, distinguish patients based on the initial event. Objectives We performed a systematic review and meta‐analysis to investigate patients with aPL and venous TE (VTE), provoked or unprovoked, and patients with arterial TE (ATE). Patients/Methods We conducted searches in PubMed, CINAHL, Cochrane, and EMBASE. Inclusion criteria were prospective trials or cohort studies investigating patients with aPL and ATE or VTE. Excluded studies did not provide estimated recurrence rates, did not specify whether the incident event was ATE or VTE, included patients with multiple events, or included <10 patients. Two‐year summary proportions were estimated using a random effects model. Results Ten studies described patients with VTE, 2 with ATE, and 5 with VTE or ATE. The 2‐year proportion for recurrent TE in patients with VTE who were taking anticoagulant therapy was 0.054 (95% confidence interval [CI], 0.037‐0.079); the 2‐year proportion for patients not taking anticoagulant therapy was 0.178 (95% CI, 0.150‐0.209). Most studies did not distinguish whether VTE were provoked or unprovoked. The 2‐year proportion for recurrent TE in patients with ATE who were taking anticoagulant therapy was 0.220 (95% CI, 0.149‐0.311); the 2‐year proportion for patients taking antiplatelet therapy was 0.216 (95% CI, 0.177‐0.261). Conclusions Patients with aPL and ATE may benefit from a different antithrombotic approach than patients with aPL and VTE. Prospective studies with well‐defined cohorts with aPL and TE are necessary to determine optimal antithrombotic strategies.

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Laboratory criteria for antiphospholipid syndrome: communication from the SSC of the ISTH

Cited by 216 publications

References 51 publications

Identification of high thrombotic risk triple‐positive antiphospholipid syndrome patients is dependent on anti‐cardiolipin and anti‐β2glycoprotein I antibody detection assays

Identification of high thrombotic risk triple‐positive antiphospholipid syndrome patients is dependent on anti‐cardiolipin and anti‐β2glycoprotein I antibody detection assays

2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)

Recurrent thrombosis in patients with antiphospholipid antibodies and an initial venous or arterial thromboembolic event: A systematic review and meta‐analysis

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