Antiphospholipid antibodies in pulmonary embolism treated with direct oral anticoagulants: Prevalence data from unselected consecutive patients

Abstract

BackgroundDirect oral anticoagulants (DOACs) are the first-choice treatment option for the prevention of the recurrence of venous thrombosis in patients with pulmonary embolism (PE); however, their effect in patients with antiphospholipid syndrome (APS) is challenged. Therefore, the prevalence of antiphospholipid autoantibodies in patients with PE is noteworthy. ObjectivesTo determine the prevalence of unselected patients presenting with PE who meet the criteria for APS based on elevated levels of anticardiolipin (aCL) and anti-β2-glycoprotein I (aβ2GPI) antibodies. MethodsConsecutive patients with PE, in whom DOACs were primarily initiated, were tested for aCL and aβ2GPI. If the levels were elevated, the tests were repeated after 12 weeks for APS diagnosis. Laboratory results and patient characteristics were retrospectively collected from a laboratory information system and electronic patient journal entries over a 2-year period. ResultsThe prevalence of APS based on consistently elevated levels of aCL or aβ2GPI was 3.7% (10 of 267 patients). Three patients were double positive. In 11 out of 21 patients (52%) with initially elevated values, the levels of the antibodies normalized after 12 weeks. The patient characteristics were largely similar in those with APS and those without APS; however, patients with APS tended to be older and more likely to receive antithrombotic treatment at the time of PE. ConclusionWe found a relatively low prevalence of APS based on aCL or aβ2GPI. The high rate of normalized levels of the antibodies after 12 weeks reaffirms the need for repeated tests for APS diagnosis. Older patients more frequently met the criteria for APS. Determining the effectiveness of DOACs in non–triple-positive patients with APS following venous thromboembolism is important to further determine the feasibility of unselected tests in patients with PE.