Prevalence of confirmed antiphospholipid syndrome in 18‐50 years unselected patients with first unprovoked venous thromboembolism

Abstract

Background Antiphospholipid syndrome (APS) is an acquired thrombophilia disorder with prevalence not completely known in patients with first unprovoked venous thromboembolic events (VTE). Recent data suggest that the management of some APS patients should be different from that of patients with other thrombophilia. Our aim was to estimate the prevalence of APS in a community‐based cohort of patients with a first unprovoked VTE. Methods We conducted a cross‐sectional study analyzing data from our computer assisted oral anticoagulant dosage program. Data of all consecutive patients aged 18 to 50 years who were seen between January 1, 2002 and December 31, 2011 for a first proximal unprovoked VTE were extracted. The prevalence and main features of patients who fulfilled the Sapporo revised criteria for APS were collected. Results and Discussion A total of 524 incident patients aged 18 to 50 years were included in the anticoagulation clinic during the study period. Of them, 491 were tested for APS and 44 (9.0%; 95% confidence interval [CI]: 6.7‐11.8) fulfilled APS criteria. Of 26 APS women, 8 (30.8%) were on combined oral contraceptive pill at the time of VTE, versus 108 (55.1%) in non‐APS women (P = .02). No difference was observed between APS and non‐APS patients in terms of gender or type of VTE. The prevalence of APS is high in young patients with a first unprovoked VTE. In the direct oral anticoagulant era, when and how to test for APS is challenging and deserves further investigation.

The prevalence of incidental uterine venous plexus thrombosis in women attending a gynecology clinic

“…The thrombophilia prevalence rates in our study concurred with these pre‐established prevalence rates for high‐risk heritable thrombophilias, with protein C and S deficiency reported to be present in up to 7% and 4.8%, respectively, of patients with VT at unusual site 29 . Of the 39 patients, three had persistent aPL, which have been estimated to be present in approximately 10% of patients with VTE 30,31 . These women, however, were offered but did not receive treatment with LMWH.…”

16th International Congress on Antiphospholipid Antibodies Task Force Report on Antiphospholipid Syndrome Treatment Trends

“…31 A cross-sectional study of 491 patients with a first unprovoked VTE also found that 9% (44/491) of patients met criteria for APS, with 1.4% (7/491) being persistently triple aPL-positive. 32 These observations raise the issue of the optimal timing for aPL testing after a first VTE.…”

“…In contrast, triple aPL-positivity persists in the majority of patients, 36,37 although it occurs in only a minority of patients with a first VTE. 31,32 Guidance regarding the timing of thrombophilia testing including testing for APS exists. 38 It may be preferable to defer screening for aPL for most patients with a new VTE in the acute setting.…”

Antiphospholipid Syndrome Is Still a Rare Disease—Estimated Prevalence in the Piedmont and Aosta Valley Regions of Northwest Italy: Comment on the Article by Duarte‐García et al

“…Some reports describe an incidence of 5 cases per 100,000 population per year and a prevalence of 40–50 per 100,000 population (1,3–6). In several recent studies, investigators attempted to estimate the prevalence of aPLs in different cohorts, such as in young patients with stroke (7), patients with pregnancy morbidity, stroke, myocardial infarction, and deep vein thrombosis (4), and patients with a first unprovoked thrombosis (8). To date, APS meets the definition of a rare disease as described by Holué (prevalence ≤5 per 10,000 population) (9).…”