Efficacy of the antiphospholipid score for the diagnosis of antiphospholipid syndrome and its predictive value for thrombotic events (original) (raw)
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Antiphospholipid antibodies and thrombosis: do test patterns identify the patients' risk?
Thrombosis Research, 2004
We retrospectively analyzed the antiphospholipid profile of 103 lupus anticoagulant-positive patients to investigate whether laboratory patterns emerged for their association with arterial and venous thrombosis in the antiphospholipid syndrome. Anticardiolipin, anti-bbetaN2-glycoprotein I and antiprothrombin antibodies were combined with coagulation tests in different patterns, which included from 2 to 5 laboratory variables. Overall, 22 out of 180 available associations reached significance: 14 with any type of thrombosis and eight with venous thrombosis. In all but two cases, anticardiolipin antibodiesN40 units were present in the laboratory patterns that reached significance. Anti-bbetaN2-glycoprotein I antibodies were present in 11 significant patterns, and antiprothrombin antibodies in seven cases. Increasing the number of variables of the laboratory patterns did not increase the odds ratio (OR) towards thrombosis. In conclusion, this analysis confirmed that the presence of IgG anticardiolipin antibodies at medium to high titres, either alone or in various combinations with other tests, is clinically useful to establish the patients' risk of thrombosis. The role of the other antiphospholipid antibodies is less clear.
Journal of Thrombosis and Haemostasis, 2007
Background: The classification criteria for antiphospholipid syndrome (APS) were updated in 2006. Objective: The aim of the study was to analyze associations between clinical complications and laboratory test abnormalities typical for APS in a group of patients with autoimmune diseases, based on the recently updated criteria. Patients/methods: Three hundred and thirty-six patients were enrolled into the study, with the majority (n = 235) suffering from systemic lupus erythematosus. Laboratory determinations included: lupus anticoagulant (LA), anticardiolipin (aCL) and anti-beta 2glycoprotein I (anti-b 2 GPI) antibodies (ABs) [of both immunoglobulin G (IgG) and IgM class]. Results: A significant association was found between laboratory and clinical features of APS; odds ratios (ORs) for thrombosis associated with the presence of LA, aCL, and anti-b 2 GPI Abs were 4.04 [95% CI: 2.44-6.68], 3.71 (95% CI 2.32-5.92) and 2.57 (95% CI 1.60-4.1), respectively. Detailed analysis showed marked differences between the risk of clinical complications associated with the presence of an antibody in the IgG class (OR 4.15, 95% CI 2.42-7.12, and OR 4.77, 95% CI 2.37-9.61 for aCL and antib 2 GPI, respectively) and in the IgM class (OR 2.2, 95% CI 1.31-3.70, and OR 1.9, 95% CI 1.15-3.14 for aCL and antib 2 GPI, respectively). The postulated inclusion of anti-b 2 GPI antibody positivity into the previous laboratory criteria changed only slightly the number of patients diagnosed with APS (from 112 to 117). Conclusions: The updated APS classification criteria clearly represent a step forward. However, our results argue against the use of overall positivity for aCL or antib 2 GPI, and favor a clear distinction between the IgG and IgM classes of antiphospholipid ABs. Patients with both LA and anti-b 2 GPI IgG or LA and aCL IgG positivity may represent the subgroups at the highest risk of thrombotic complications.
Journal of Thrombosis and Haemostasis, 2012
To evaluate the clinical accuracy of antiphospholipid antibody (aPL) specificities both individually and/or in combination, in a wide cohort of systemic lupus erythematosus (SLE) patients in an attempt to identify a panel of tests that may provide the best accuracy for diagnosing antiphospholipid syndrome (APS). Patients and Methods:This study included 230 patients (218 women, mean age 42.7 ± 11.9 years, mean disease duration 12.2 ± 8.7 years), all fulfilling the 1982 criteria for SLE. All patients were tested for lupus anticoagulant (LA), anti-cardiolipin (aCL), anti-β 2glycoprotein I (anti-β2GPI), solid phase anti-prothrombin (aPT), anti-phosphatidylserine/prothrombin (aPS/PT), and antiphosphatidylethanolamine (aPE) antibodies. Sensitivity, specificity and predictive values were calculated. The diagnostic accuracy for each combination of tests was assessed by ROC and their area under the curve analysis as well as by the Youden's index (YI). Results:Testing for six aPL derived 23 possible combinations of results. Among them, LA + anti-β 2GPI + aPS/PT had the best diagnostic accuracy for APS as a whole and individually for both thrombosis and pregnancy loss (AUC 0.712, OR 3.73 [95% CI 1.82-5.38],P = 0.0001, YI = 0.32 and AUC 0.709, OR 3.75 [95% CI 2.13-6.62], P = 0.0001, YI = 0.37 and AUC 0.677, OR 4.82 [95% CI 2.17-10.72], P = 0.0007, YI = 0.38, respectively) and the best specificity when compared with all the other obtainable combination of tests. Triple positivity for LA + anti-β2GPI + aPS/PT was more strongly associated with clinical events (thrombosis and/or PL) when compared with double or single positivity (OR 23.2 [95% CI 2.57-46.2] vs. OR 7.3 [95% CI 2.21-25.97], OR 5.7 [95% CI 2.12-17.01] or OR 3.11 [95% CI 1.56-7.8] for single positivity for LA, aPS/PT and anti-β2GPI, respectively). Conclusions:Combining LA, anti-β 2GPI and aPS/PT improves the diagnostic power and helps in stratifying the risk for each patient, according to their aPL profile.
Antiphospholipid Antibody Syndrome-Diagnostic Issues of Lupus Anticoagulants
Journal of Hematology & Thromboembolic Diseases
Antiphospholipid antibody syndrome is a serious autoimmune disorder which can lead to multisystem manifestations from recurrent thrombosis to pregnancy loss to intrauterine death and other obstetric morbidities. In few cases it may lead to catastrophic syndrome. Antiphospholipid antibodies are circulating antibodies which bind with the plasma proteins which in turn bind to phospholipids and thus lead to pathogenesis. Despite of so many researches done in the field of APLA, the mechanisms leading to obstetric complications are still debatable. Antiphospholipid antibodies are detected on the basis of solid phase assays which comprised of anticardiolipin (acl) antibody and Anti β2 glycoprotein (aB2GP) and the other one is liquid phase assays which identifies lupus anticoagulants (LAC). While aB2GP and acl are being detected most commonly by ELISA, LAC is being detected by clot based test. Lupus anticoagulant is a double misnomer as most patients don't have systemic lupus erythematous and in vivo reacts as procoagulants.
Blood, 2002
To formally establish the risk of lupus anticoagulants and anticardiolipin antibodies for arterial and venous thrombosis, we ran a MEDLINE search of the literature from 1988 to 2000. Studies were selected for their case-control (11), prospective (9), cross-sectional (3), and ambispective (2) design. They provided or enabled us to calculate the odds ratio with 95% confidence interval (CI) of lupus anticoagulants and/or anticardiolipin antibodies for thrombosis in 4184 patients and 3151 controls. Studies were grouped according to the antibody investigated. Five studies compared lupus anticoagulants with anticardiolipin antibodies: the odds ratio with 95% CI of lupus anticoagulants for thrombosis was always significant. None of them found anticardiolipin antibodies were associated with thrombosis. Four studies analyzed only lupus anticoagulants: the odds ratio with 95% CI was always significant. The risk of lupus anticoagulants was independent of the site and type of thrombosis, the pr...
The impact of antibody profile in thrombosis associated with primary antiphospholipid syndrome
American journal of hematology, 2017
Triple positivity (TP) for antiphospholipid antibodies(aPL) may identify aPL carriers with poorer prognosis. The clinical impact of TP in primary antiphospholipid syndrome(PAPS) remains unclear and further clinical evidences are needed to validate TP as a marker of severity. The aim of this study was to evaluate the impact of TP on the clinical course of PAPS with thrombosis(t-PAPS). We performed a retrospective analysis of a cohort of t-PAPS patients, comparing groups of patients with TP and non-TP profiles according to their demographic, clinical and laboratory features. We included 105 patients with t-PAPS, the median follow-up time of 3.7 years. Twenty-two patients(21%) had TP; the demographic distribution, the presence of cardiovascular risk factors and the site of thrombosis were similar between TP and non-TP patients. The frequency of thrombotic events did not differ between TP and non-TP patients during the study period. Pregnancy morbidities were more frequent in women with...
The Journal of rheumatology, 2003
To investigate the utility of receiver operating characteristic (ROC) analysis in determining the strength of association between various antiphospholipid and anti-protein cofactor antibodies (aPA) and thrombosis, pregnancy morbidity, and thrombocytopenia. Clinical and laboratory variables were retrospectively studied in 204 patients: 160 with systemic lupus erythematosus (SLE), 22 with lupus-like syndrome (SLE-LS), and 22 with primary antiphospholipid syndrome (APS). Laboratory evaluation included detection of lupus anticoagulant (LAC) and measurement of IgG and IgM anticardiolipin (aCL), antiphosphatidylserine (aPS), antiphosphatidylinositol (aPI), anti-beta 2 glycoprotein I (a beta 2GPI), and antiprothrombin (aPT) antibodies. ROC plot analysis was used to determine the clinical accuracy of aPA tests, and calculate cut-off values which best associate with clinical symptoms typical for APS. The LAC was associated with a history of thrombosis [odds ratio (OR): 3.04; 95% confidence i...