Diagnosis of antiphospholipid syndrome in routine clinical practice (original) (raw)
Related papers
Significance of antiphospholipid antibodies in patients with bad obstetric history
Indian Journal of Medical Sciences, 2007
Background: Some autoantibodies have been associated with lupus nephritis but the role of antiphospholipid antibodies (APA) is controversial. Objective: The present study was to explore the role of APA by comparing demographic profiles and the presence of anticardiolipin antibody (aCL) and lupus anticoagulant (LA) in systemiclupus erythematosus (SLE) patients with and without nephritis. Material and Method: The cross-sectional study in a tertiary center was conducted in 77 SLE patients. All patients attended our renal or rheumatology clinics between June 2002 and December 2003. Results: Sixty-three (82%) of the 77 SLE patients had nephritis. The prevalence of antiphospholipid syndrome (APS) was 10% (8 patients), positive aCL (IgG) was 26% (20 patients) and positive LA was 26% (20 patients). The receiver operating characteristic (ROC) method was applied to assess the significance of aCL in both nephritis and non-nephritis groups. Area under the ROC curve was 0.538 (95%CI 0.312-0.765), a cutoff value of 20.5 GPL had a sensitivity of 75% and a specificity of 53%. In univariate analysis, neither positivity for anticardiolipin antibody nor lupus anticoagulant was associated with lupus nephritis. Analyzed in only the lupus nephritis group, LA-positive lupus nephritis patients had higher systolic blood pressure (SBP) (133.7 vs 121.9 mmHg, p = 0.005), lower platelet count (209.8 vs 264.4 x 10 3 /µL, p = 0.02) and higher 24-hr urine protein excretion (2.6 vs 1.4 g, p = 0.02) than LA-negative lupus nephritis patients. Serum creatinine was higher in LA-positive lupus nephritis than LA-negative (233.0 vs 94.9 µmol/L), but did not reach statistical significance. Conclusion: APA are frequently seen in SLE patients, but not associated with lupus nephritis. However, lupus anticoagulant tends to associate with lupus nephritis. Detection of LA in lupus nephritis patients could identify patients who had increased risk to develop bad renal outcomes (elevated SBP and 24-hr urine protein excretion).
BACKGROUND: Antiphospholipid syndrome (APS) is an autoimmune, hypercoagulable state caused by antiphospholipid antibodies. Anticardiolipin antibodies (aCL), anti-β2 glycoprotein-I (ab2GPI) and lupus anticoagulant (LA) are the main autoantibodies found in APS. Despite the amassed body of clinical knowledge, the risk of obstetric complications associated with specific antibody profile has not been well established. OBJECTIVE: To assess the risk of obstetric complications in women with primary APS associated with specific antibody profile STUDY DESIGN: The PREGNANTS study is a multicenter, retrospective, cohort study. Diagnosis and classification of APS were based on the 2006 International revised criteria. All women included in the study had at least one clinical criteria for APS, were positive for at least one antiphospholipid antibodies (aCL, ab2GPI and/or LA), and were treated with low-dose aspirin and prophylactic low molecular weight heparin (LMWH) starting from the first trimester. Only singleton pregnancies with primary APS were included. The primary outcome was livebirth, defined as any delivery of a live infant after 22 weeks. The secondary outcomes were preeclampsia with and without severe features, intrauterine growth restriction (IUGR) and stillbirth. We planned to assess the outcomes associated with the various antibody profile (test result for LA, aCL and ab2GPI). RESULTS: There were 750 singleton pregnancies with primary APS in the study cohort. 54 (7.2%) were positive for LA only, 458 (61.0%) for aCL only, 128 (17.1%) for ab2GPI only; while 90 (12.0%) were double positive and LA negative and 20 (2.7%) were triple positive. The incidence of livebirth in each of these categories was 79.6%, 56.3%, 47.7%, 43.3%, and 30.0%, respectively. Compared to women with only one antibody positive test results, women with multiple antibody positive results had a significantly lower livebirth (40.9% vs 56.6%; aOR 0.71, 95% CI 0.51 to 0.90). Also, they were at increased risk of preeclampsia without (54.5% vs 34.8%; aOR 1.56, 95% CI 1.22 to 1.95) and with severe features (22.7% vs 13.8%, aOR 1.66, 95% CI 1.19 to 2.49), IUGR (53.6% vs 40.8%; aOR 2.31, 95% CI 1.17 to 2.61) and stillbirth (36.4% vs 21.7%; aOR 2.67, 95% CI 1.22 to 2.94). In women with only one positive test result, women with ab2GPI positivity present alone had a significantly lower livebirth (47.7% vs 56.3% vs 79.6%; p<0.01), and a significantly higher incidence of preeclampsia without (47.7% vs 34.1% vs 11.1%; p<0.01) and with severe features (17.2% vs 14.4% vs 0%; p=0.02), IUGR (48.4% vs 40.1% vs 25.9%; p<0.01) and stillbirth (29.7% vs 21.2% vs 7.4%; p<0.01) compared to women with aCL and to women with LA present alone, respectively. In the group of women with more than one antibody positivity, triple-positive women had lower livebirth (30% vs 43.3%; aOR 0.69, 95% CI 0.22 to 0.91), and higher incidence of IUGR (70.0% vs 50.0%; aOR 2.40, 95% CI 1.15 to 2.99) compared to double positive and LA negative women. CONCLUSION: In singleton pregnancies with primary APS, aCL is the most common sole antiphospholipid antibody present, but ab2GPI is the one associated with the lowest livebirth rate and highest incidence of preeclampsia, IUGR, and stillbirth, compared to presence of aCL or LA alone. Primary APS women have an increased risk of obstetric complications and lower livebirth when more than one antiphospholipid antibody is present. Despite therapy with low-dose aspirin and prophylactic LMWH, chance of a live-birth neonate is only 30% for triple-positive women.
Non-Criteria or Seronegative Obstetric Antiphospholipid Syndrome?
The Israel Medical Association journal : IMAJ, 2017
Obstetric antiphospholipid syndrome (Obs-APS) is one of the most commonly identified causes of recurrent pregnancy loss and its accurate diagnosis is a requirement for optimal treatment. Some patients do not fulfill the revised Sapporo classification criteria, the original APS classification criteria, and are considered to be non-criteria Obs-APS. In these patients with non-criteria, there is controversy about their inclusion within the spectrum of APS and eventually their treatment as having Obs-APS. A subset of patients may also have clinical characteristics of Obs-APS even though lupus anticoagulant (LA), anticardiolipin antibodies, and anti-β2-glycoprotein I (aβ2GPI) antibodies are consistently negative. These patients are recognized as seronegative Obs-APS. We reviewed evidence of non-criteria Obs-APS and discuss a case of a woman with a diagnosis of active systemic lupus erythematosus (SLE) and non-criteria Obs-APS with four consecutive pregnancy losses. After an accurate diag...
Seminars in Arthritis and Rheumatism, 2016
APL group. 136/474 (29%) patients have been treated during pregnancies and treatment significantly increased the rate of live birth (26% in untreated versus 72% in treated pregnancies, p<0.0001). In univariate analyses, treatment effect on pregnancies losses was similar in patients with APS and nonconventional APS, with odds ratio at 3.3 [95% CI; 1.8 to 6.1] and 6.9 [95% CI; 3.9 to 12.3] (p=0.49) and significantly more important for the 2 APS groups pooled versus non-APL group (OR at 1.9 [95% CI; 1.1 to 3.5] for non-APL group versus 5.3 [95% CI; 3.5 to 8.1] for APS groups, p=0.0025). Conclusion In this study 68% of patients with clinical criteria for obstetrical APS seronegative for conventional APL have non-conventional APL. These patients have a significant decrement of pregnancy losses if they receive treatment for APS during their pregnancy.
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.
Immunologic research, 2018
Serological risk factors are the most important determinant in predicting unsuccessful pregnancy in obstetric antiphospholipid antibodies syndrome (OAPS) despite conventional treatment. It is not clear if changes in the profile of antiphospholipid antibodies (aPL) during pregnancy modify the risk associated with a poor response to conventional treatment. The aim of our study was to compare the value of a serological tag for aPL obtained before and during the first trimester of pregnancy to predict the response to conventional treatment. We carefully selected 97 pregnancies in women who were included in our study only if they were diagnosed with OAPS prior to a new pregnancy (basal serological risk), retested for aPL during the first trimester of pregnancy (serological risk during pregnancy), and treated with conventional therapy. High baseline serological risk was associated with pregnancy failure in 62.1% of cases (18/29) and predicted 82.5% of pregnancy outcomes with conventional ...
Journal of SAFOG, 2022
Background: Antiphospholipid syndrome (APS) is one of the important treatable causes of bad obstetric history (BOH). The literature on the association between the presence of antiphospholipid antibodies (APLA) in patients with BOH and clinical parameters is limited. Aims and objectives: (1) To estimate the prevalence of APLA in patients with BOH and (2) To determine the association of APLA with various clinical parameters in patients with BOH. Materials and methods: A total of 80 patients with BOH of unknown etiology and 40 age-matched controls with at least 1 successful pregnancy outcome were clinically assessed and screened for the presence of APLA {anti-β2 glycoprotein-1-IgG (ABGP1-IgG); anticardiolipin IgG and IgM [anticardiolipin antibodies (ACLA), ACLA-IgG and-IgM)]; and lupus anticoagulant (LAC)}. The clinical parameters of APLA-positive and APLAnegative cases were compared. Results: Antiphospholipid antibodies were detected in 12 of 80 cases (15%) compared with none among controls [odds ratio (OR) = 29.38; 95% confidence interval (CI) = 1.71-505.4; p = 0.0199]. The antibody ABGP1-IgG was the commonest one (n = 7, 58.33%) followed by LAC (n = 4, 33.33%) and ACLA-IgG and-IgM (1 each). Patients with APLA-positive BOH had significantly increased incidence of thrombotic episodes (p = 0.01), hypertension (p = 0.05), thrombocytopenia p <0.01), and anemia (9.67 ± 1.75 vs 11.04 ± 1.37 gm/dL; p <0.01). Second-trimester abortion was significantly higher (p = 0.03), and first-trimester abortions were significantly lesser (p = 0.02) compared with patients with APLA-negative BOH. Third-trimester adverse obstetric events were comparable between the two groups. Conclusion: Antiphospholipid antibodies are present in 15% of patients with BOH of unknown etiology. History of thrombosis, hypertension, thrombocytopenia, anemia, and second-trimester abortions were significantly associated with the presence of APLA in BOH. Clinical significance: The findings from this study will help in determining the subset of patients with BOH who have higher likelihood of presence of APLA and therefore increase the chances of treatment and a successful pregnancy outcome.
Seminars in Thrombosis and Hemostasis, 2008
The antiphospholipid syndrome (APS) in pregnancy is associated with repeated miscarriages and fetal loss. Other complications of pregnancy such as preeclampsia and placental insufficiency are also frequently reported during pregnancy in APS. The pathogenesis of pregnancy failures in APS is related to both the thrombophilic effect of antiphospholipid antibodies and also to different mechanisms including a direct effect of antibodies on trophoblast differentiation and invasion. Although optimal pharmacologic treatment is essential to achieve a successful outcome in APS pregnancy, the standard APS pharmacologic treatment alone may not be sufficient. A good obstetric outcome is the result of careful obstetric monitoring, proper delivery timing, and skillful neonatal care. A multidisciplinary team (obstetricians, rheumatologists, and neonatologists) and the progress in neonatal intensive care are as important as drugs in achieving a good obstetric outcome and to reduce the possible consequences of premature delivery.