Predictive value of persistent versus transient antiphospholipid antibody subtypes for the risk of thrombotic events in pediatric patients with systemic lupus erythematosus

Male, Christoph; Foulon, D; Hoogendoorn, Hugh; Vegh, Patsy; Silverman, Earl D.; David, Michèle; Mitchell, Lesley

doi:10.1182/blood-2005-05-2048

Cited by 104 publications

(61 citation statements)

References 41 publications

(51 reference statements)

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“…It is also essential to establish the risk profile of the individual patient in order to guide his/her primary or secondary thromboprophylaxis. LAC consistently shows the highest strength of association with the arterial and venous thrombotic complications and pregnancy morbidity [9,10] in adults, as well as in children with thrombosis and systemic lupus erythematosus [11], and is, thus, the assay of choice for the detection of aPL. ab2-GPI and aCL ELISAs should, when performed according to the original criteria, measure the same population of antibodies.…”

Section: Referencesmentioning

confidence: 99%

Invitation to a debate on the serological criteria that define the antiphospholipid syndrome

et al. 2008

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(patients with no observable tricuspid regurgitation), the strength of correlation of RVSP versus PVO% increased slightly (r 2 = 0.147, plot not shown). We then constructed a multivariate regression model to determine the significance of each predictor variable. The resultant equation was as follows: PVO% = 0.331242 ) 0.001554 SaO 2 % + 0.001882 HR + 0.002051 D-dimer ) 0.111275 Troponin + 0.037913 log(BNP) + 0.004763 RVSP.When we performed a t-test on each coefficient, only the RVSP coefficient was significant (P = 0.0003).We also performed follow-up at 6 months in all survivors (n = 182) and 15 patients reported recurrent deep venous thrombosis (DVT) and three other patients reported recurrent PE (including one with PE and DVT). The three patients with recurrent PE had percentage occlusion values of 95%, 80% and 5%.Our data suggest that the PVO%, a ready index of clot size, correlated poorly with five of six independent variables tested. We found the virtual absence of a correlation between heart rate, SaO 2 %, troponin I and BNP vs. PVO%. We found that RVSP had the tightest correlation with PVO%, although the correlation we observed between RVSP from echocardiography vs. PVO% from CTA was much weaker than correlations previously reported between RVSP and pulmonary vascular resistance, when both parameters were measured with formal pulmonary angiography [6]. PE renders a complex set of stresses to the human body, including global circulatory insufficiency, shear stress and ischemia in the right ventricular muscle, abnormalities in gas exchange, and cardiopulmonary inflammation. Each of the six independent variables clearly measure important host responses to the stress of PE: heart rate reflects baroreceptor unloading; SaO 2 reflects ventilationperfusion mismatch; D-dimer reflects fibrin mass and fibrinolytic activity; troponin and BNP reflect cardiomyocyte damage; and RVSP reflects impedence to RV systolic ejection. Because only three out of 182 survivors reported recurrent PE, we cannot make any inference as to whether clot size predicts PE recurrence. In summary, we believe these data underscore the notion that clot size should not be viewed as the predictor-inchief in assessing PE severity. Disclosure of Conflict of InterestsThe authors state that they have no conflict of interest.

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Section: Referencesmentioning

confidence: 99%

Invitation to a debate on the serological criteria that define the antiphospholipid syndrome

et al. 2008

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“…[497][498][499] There is no direct evidence to guide the optimal therapy for DVT in children with APLAs or to support or refute the role of primary prophylaxis. Recommendation 2.26.…”

Section: Children With Antiphospholipid Antibodies and Dvtmentioning

confidence: 99%

Antithrombotic Therapy in Neonates and Children

Monagle

Chan

Goldenberg

et al. 2012

Chest

1,235

559

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“…Persistent positivity of laboratory tests is important (52 ), since transient presence of epiphenomenal APAs may give rise to misclassification. It has been suggested not to classify APS when the time interval between the clinical event and the positive laboratory test exceeds 5 years; a time interval exceeding 12 weeks between symptom and test requires careful assessment of the relationship between clinical manifestations and APAs (22 ).…”

Section: Laboratory Diagnosismentioning

confidence: 99%

Challenges in the Diagnosis of the Antiphospholipid Syndrome

Devreese

Hoylaerts

2010

Clinical Chemistry

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BACKGROUND:The antiphospholipid syndrome (APS) is an important cause of acquired thromboembolic complications and pregnancy morbidity. Its diagnosis is based on clinical and laboratory criteria, defined by strict guidelines. The original clinical and laboratory criteria for the identification of APS patients were published in 1999, in the so-called Sapporo criteria. In 2006 these criteria were revised, and recently more precise guidelines for analysis of the lupus anticoagulant have been provided. However, several questions related to the diagnosis of APS remain unanswered.CONTENT: In addition to providing a historical perspective, this review covers several challenges in the diagnosis of APS with respect to clinical and laboratory features, while highlighting pathogenic pathways of the syndrome. We discuss ongoing dilemmas in the diagnosis of this complex disease. Although antiphospholipid antibodies are found in association with various clinical manifestations, the older established clinical criteria were not substantively altered in the 2006 update. Several laboratory tests recommended in the latest criteria, including phospholipid-dependent coagulation tests for the detection of the lupus anticoagulant and ELISAs for measuring anticardiolipin and ␤2-glycoprotein I antibodies, still show methodological and diagnostic shortcomings. In addition, antiphospholipid antibodies have been described against other antigens, but their clinical role remains uncertain.

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Predictive value of persistent versus transient antiphospholipid antibody subtypes for the risk of thrombotic events in pediatric patients with systemic lupus erythematosus

Cited by 104 publications

References 41 publications

Invitation to a debate on the serological criteria that define the antiphospholipid syndrome

Invitation to a debate on the serological criteria that define the antiphospholipid syndrome

Antithrombotic Therapy in Neonates and Children

Challenges in the Diagnosis of the Antiphospholipid Syndrome

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