The Diagnosis of the Antiphospholipid Syndrome

Pengo, Vittorio; Ruffatti, Amelia; Iliceto, Sabino

doi:10.1159/000093564

Cited by 33 publications

(41 citation statements)

References 30 publications

(26 reference statements)

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“…Although the criterion of single test positivity was maintained at the recent Sydney consensus conference, the association of a single positive test with clinical events appears weaker. 6,8 Further studies will clarify the nature of the differences observed in the laboratory profiles of LAC positive subjects with or without relevant clinical events.From Clinical Cardiology (V.P., A.B. ),…”

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confidence: 99%

A Comparison of Lupus Anticoagulant–Positive Patients With Clinical Picture of Antiphospholipid Syndrome and Those Without

Pengo¹,

Biasiolo

Gresele³

et al. 2007

ATVB

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A mong antiphospholipid antibodies, Lupus Anticoagulant (LAC) is recognized as the strongest risk factor for thromboembolic events or pregnancy morbidity. 1 The presence of LAC in a subject with previously documented thromboembolism or a significant history of pregnancy loss defines the Antiphospholipid Syndrome (APS). Some patients, however, are diagnosed with LAC without ever having experienced previous vascular thrombosis or pregnancy morbidity. The antiphospholipid antibody profiles of LAC positive patients with or without associated clinical features of APS have been evaluated by us in a multicenter study.Centers affiliated with Italian Federation of Thrombosis Centers (FCSA) were invited to identify consecutive LAC positive patients diagnosed over a 1-year period. Three hundred twenty-one recruited patients were contacted and after giving informed consent they underwent testing for LAC after at least 12 weeks from the first one using routine laboratory procedures. LAC was not confirmed by Thrombosis Centers in 19 patients (6 were children with previous acute infections). The plasma samples of 302 patients were sent to a central reference laboratory for final LAC confirmation and measurement of anticardiolipin (aCL) and anti-human ␤2-Glycoprotein I (a␤2GPI) antibodies by ELISA, as previously described. [2][3][4] On the basis of the results obtained, these patients were classified as category I when either IgG/IgM aCL or IgG/IgM a␤2GPI were also positive and as category IIa when LAC alone was positive. 5 Fisher exact test (using Woolf approximation) was performed for the comparisons of categorical variables. dRVVT ratios were compared by the unpaired student t test. aCL and a␤2GPI antibody values were compared by the nonparametric Mann-Whitney U test.Of the 231 patients whose positivity to LAC was confirmed by a central reference laboratory, 152 reported clinical events and had been diagnosed with APS (LAC/APS group) whereas 79 had no previous thromboembolic events or pregnancy morbidity (LAC/no APS group).The subjects in the LAC/APS group were slightly younger, and two-thirds in both groups were female. The ratio between the coagulation times of mixing to control plasma was used to compare LAC potency. Patients in the LAC/APS group had a 1.75Ϯ0.55 dRVVT ratio whereas those in the LAC/noAPS group had a 1.59Ϯ0.43 dRVVT ratio (Pϭ0.02).As shown in the Figure Of the 152 patients in LAC/APS group, 96 were also positive for IgG aCL or IgG a␤2GPI (71 had triple positivity) and were classified as category I. The rate of patients in category I in the LAC/APS group was significantly higher than that in the LAC/noAPS one (63% versus 30%, ORϭ3.3, 95%CI 2.2 to 7.0, PϽ0.001). On the other hand, the frequency of LAC positivity alone (classification category IIa) was significantly higher in the LAC/noAPS group (51% versus 28%, ORϭ2.7, 95%CI 1.5 to 4.7, PϽ0.001).With reference to a large number of patients with LAC, the LAC/APS group was found to have a stronger LAC potency and higher titers of IgG aCL and IgG a␤2GPI. This i...

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confidence: 99%

A Comparison of Lupus Anticoagulant–Positive Patients With Clinical Picture of Antiphospholipid Syndrome and Those Without

Pengo¹,

Biasiolo

Gresele³

et al. 2007

ATVB

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“…In a UK series of 193 consecutive patients, a single instance of aCL/anti-β 2 -GPI antibody positivity was detected in 11.5% of patients with obstetric APS 10 ; in a multicenter European cohort, 31 out of 73 women with purely obstetric APS carried a single positivity in either aCL or anti-β 2 -GPI antibody assays 11 . Consistently, double aPL positivity with negative LAC emerged as a strong risk factor for obstetric, but not thrombotic, APS complications, with an OR of 10.8 12 . Thus the importance emerges of taking results in ELISA tests into account when diagnosing obstetric APS, even in the context of a mere single positivity at medium-high titers.…”

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confidence: 68%

Obstetric Antiphospholipid Syndrome: Lobsters Only? Or Should We Also Look for Selected Red Herrings?

et al. 2015

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“…Most importantly, it appears that the risk of thrombosis progressively increases with the number of positive aPL tests. While this concept has already been described for the so-called "triple positivity" for aCL, anti-β2GPI and LA [36], quadruple positivity for LA, aCL, anti-β2GPI and aPT has been shown to confer a 30-fold higher risk of thrombosis, much higher risk than with the former combination [34,35].…”

Section: Clinical Significancementioning

confidence: 99%

New Tests to Detect Antiphospholipid Antibodies: Antiprothrombin (aPT) and Anti-Phosphatidylserine/Prothrombin (aPS/PT) Antibodies

2014

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Antiprothrombin antibodies have been proposed as potential new biomarkers for thrombosis and/or pregnancy morbidity in the setting of the antiphospholipid syndrome (APS). Antiprothrombin antibodies are commonly detected by ELISA, using prothrombin coated onto irradiated plates (aPT), or prothrombin in complex with phosphatidylserine (aPS/PT), as antigen. Although these antibodies can co-exist in the same patient, aPT and aPS/PT seem to belong to different populations of autoantibodies. Early research explored the role of antibodies to prothrombin as potential antigenic targets for the lupus anticoagulant (LA). To date their clinical significance is being investigated and their potential role in identifying patients at higher risk of developing thrombotic events or pregnancy morbidity is being probed.

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The Diagnosis of the Antiphospholipid Syndrome

Cited by 33 publications

References 30 publications

A Comparison of Lupus Anticoagulant–Positive Patients With Clinical Picture of Antiphospholipid Syndrome and Those Without

A Comparison of Lupus Anticoagulant–Positive Patients With Clinical Picture of Antiphospholipid Syndrome and Those Without

Obstetric Antiphospholipid Syndrome: Lobsters Only? Or Should We Also Look for Selected Red Herrings?

New Tests to Detect Antiphospholipid Antibodies: Antiprothrombin (aPT) and Anti-Phosphatidylserine/Prothrombin (aPS/PT) Antibodies

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