Abstract
Antibodies to phospholipids (aPL) and associated proteins are a hallmark in the diagnosis of anti-phospholipid syndrome (APS). Those included in the classification criteria are the lupus anticoagulant (LA) and the IgG and IgM isotypes of anticardiolipin (aCL) and anti-beta-2 glycoprotein I (β2GPI) antibodies. Non-classification criteria markers such as autoantibodies that recognize the phosphatidylserine/prothrombin (aPS/PT) complex have been proposed as biomarkers for APS. Studies of aPS/PT antibodies have shown a strong correlation to clinical manifestations and LA. We aimed to study the value and the persistence of aPS/PT IgG and IgM antibodies in a cohort of consecutive patients with clinical suspicion of APS and their utility as thrombotic risk markers. Our study, with 103 patients, demonstrates that persistently positive results for aPS/PT IgG antibodies were significantly associated with APS classification, thrombosis, triple aPL positivity, LA positive result, and the Global APS Score (GAPSS) > than 9 points (p < 0.01, for each condition). On the other hand, no association was seen with pregnancy morbidity (p = 0.56) and SLE (p = 0.07). Persistence of aPS/PT antibodies, defined according to the current laboratory classification criteria, likely improves the diagnosis and clinical assessment of patients with APS.
Highlights
Antiphospholipid syndrome (APS) is a systemic autoimmune disease that is characterized by vascular thrombosis and/or well-defined obstetric complications that occur in patients with persistent anti-phospholipid antibodies (Ab) [1]
Various studies have been conducted to assess whether this effect appeared with the use of new direct oral anticoagulants (DOACs) that directly inhibit a specific factor in the coagulation cascade, for example, those targeted to thrombin and factor Xa, which are used worldwide to prevent and to treat thromboembolism, embolic stroke associated with non-valvular atrial fibrillation, and acute coronary syndromes [7]
Four study groups were included: 25 (24%) patients with APS, 17 of them with primary APS; 30 (29%) patients with systemic lupus erythematous (SLE); 22 (21%) patients defined as nonAPS, but who suffered from thrombosis and/or obstetric complications included in the classification criteria for APS [19] in the absence of positive aPL in two determinations (n = 19) or with only one positive aPL determination (n = 3); and 26 (25%) patients who were referred for aPL testing for other reasons (Others group)
Summary
Antiphospholipid syndrome (APS) is a systemic autoimmune disease that is characterized by vascular thrombosis and/or well-defined obstetric complications that occur in patients with persistent anti-phospholipid (aPL) antibodies (Ab) [1]. It seems clear that in APS Ab profiles, rather than isolated results, best define the risk of patients to develop the clinical manifestations of this syndrome [4]. In this sense, including new Ab can add value to improve the stratification of patients and help in the interpretation of results, since discrepant results often appear for different reasons. Depending on the test used for LA determination, based on different principles, in patients treated with DOACs, different results were obtained At this time, it does not seem advisable to carry out LA testing during anti-factor Xa and anti-factor IIa treatment because of the risk of false-positive results [8]. It is recommended to wait at least 72 h after the last dose of DOACs for the investigation of LA [9]
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