Risk Assessment and Antithrombotic Strategies in Antiphospholipid Antibody Carriers

Abstract

Antiphospholipid antibodies (aPL) are a cluster of autoantibodies directed against plasma proteins with affinity for membrane phospholipids. The most frequently tested aPL are lupus anticoagulant (LA), anti-cardiolipin antibodies (aCL), and anti-β2-glycoprotein I antibodies (anti-β2GPI). aPL play a key pathogenic role in the development of the antiphospholipid syndrome (APS), a systemic autoimmune disease characterized by recurrent thrombotic and/or pregnancy complications in patients with persistent aPL. However, aPL positivity is occasionally documented in patients with no previous history of thrombotic or pregnancy morbidity. LA activity, multiple aPL positivity, high-titer aPL, and a concomitant systemic autoimmune disease are recognized risk factors for future thrombotic events in asymptomatic carriers. Moreover, an accelerated atherosclerosis with increased cardiovascular (CV) risk has also been associated with aPL positivity, thus exposing aPL carriers to fatal complications and chronic disability requiring cardiac rehabilitation. Overall, an accurate risk stratification is recommended for aPL-positive subjects in order to prevent both venous and arterial thrombotic complications. In this review, we provide an overview of the main antithrombotic and risk assessment strategies in aPL carriers.

Added value of antiphosphatidylserine/prothrombin antibodies in the workup of thrombotic antiphospholipid syndrome: Communication from the ISTH SSC Subcommittee on Lupus Anticoagulant/Antiphospholipid Antibodies

“…High titers of antibodies are considered to be more associated with clinical events in APS, as well as in specific AIDs 63,64 and increasing titers of autoantibodies are associated with a higher likelihood of having the disease. [64][65][66] In this study, we demonstrated that higher titers of aPS/PT IgG and IgM were associated with higher LR for TAPS.…”

Detection of IgA Antiphospholipid Antibodies Does not Improve Thrombotic Antiphospholipid Syndrome Classification: A two-Center Study

“…29,30 In contrast, high levels of aPL strongly predict future thrombosis with and without underlying autoimmune diseases. 31,32 Consequently, we hypothesized that single IgA-positive individuals may be less likely to develop APS than dual- or triple-positive individuals. IgA-positive individuals can be classified into two categories: first, multiple aPL-positive group, whereby IgA coexists with IgM/IgG antibodies and can be identified with the conventional aPL assays; second, isolated IgA-positive group with a low risk of APS due to the low levels of antibodies.…”

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

“…Indeed, a specific positivity for aPL, the number of aPL positive tests (single, double, or triple positivity), and the titer and isotype of aPL may all influence the risk of thrombosis development. 17 In particular, it has been reported that triple positivity is strongly correlated with the thrombotic risk. 18 We found that of the 53 women included, five women tested positive for aPL and we have three cases with isolated LAC, one case with isolated IgG aCL and one case with triple positivity (LAC, aCL IgM, aβ2GPI IgM).…”

“…Several pieces of evidence suggest that the aPL profile is linked to thrombotic risk. Indeed, a specific positivity for aPL, the number of aPL positive tests (single, double, or triple positivity), and the titer and isotype of aPL may all influence the risk of thrombosis development 17 . In particular, it has been reported that triple positivity is strongly correlated with the thrombotic risk 18 .…”