Antiphospholipid Antibody Testing in a General Population Sample from the USA: An Administrative Database Study

Giordano Egiziano,Anisur Rahman,Evelyne Vinet,Jessica Widdifield,Sasha Bernatsky,Jeffrey R Curtis,Cristiano S Moura

doi:10.1038/s41598-020-59990-5

Giordano Egiziano, Anisur Rahman + Show 5 more

Open Access

https://doi.org/10.1038/s41598-020-59990-5

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Abstract

We sought to characterized patterns of aPL testing in a large general population sample from the United States. Using Truven Health MarketScan laboratory data from 2010–2015 we identified individuals tested for lupus anticoagulant(LA), anti-cardiolipin (aCL), and anti-beta2-glycoprotein1(aGP1). Our research was approved by the McGill institutional review board (A04-M47-12B). We identified 33,456 individuals with at least one aPL test. Among these, only 6,391 (19%) had all three tests (LA, aCL, aGP1) performed. Confirmatory aPL testing was performed at least 12 weeks later in 77%, 45%, and 41% of initially positive LA, aCL, and aGP1, respectively. Of those re-tested after ≥12 weeks, only 255 (10.6%) were found to have a confirmatory positive aPL test. These findings highlight that aPL testing may often be incompletely performed. Further investigations will be required to better understand the low rate of a confirmatory positive aPL test ≥12 weeks after the initial test.

Highlights

The antiphospholipid syndrome (APS) is defined by vascular thrombosis or pregnancy morbidities in the presence of persistently circulating antiphospholipid antibodies[1]
We identified 33,456 individuals with at least one aPL test (Table 1)
To comply with the revised Sydney classification criteria for APS, an initially positive aPL test must be repeated after ≥12 weeks

Summary

Introduction

The antiphospholipid syndrome (APS) is defined by vascular thrombosis or pregnancy morbidities in the presence of persistently circulating antiphospholipid antibodies (aPL)[1]. APS may arise secondarily in patients with autoimmune diseases, systemic lupus erythematosus (SLE), or be a primary condition unassociated with an autoimmune disease[2,3]. Little is known regarding whether clinicians test for aPL according to the revised Sydney APS classification criteria[1]. Since aPL may be transiently elevated by infections, malignancy or certain medications, repeat testing at an interval of 12 or more weeks is required to confirm the presence of a circulating aPL when establishing a diagnosis of APS2. Given the various gaps in our current understanding of aPL testing in practice, we sought to characterize patterns of aPL testing in a large general population sample

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Results

Conclusion