Estimated Frequency of Antiphospholipid Antibodies in Patients With Pregnancy Morbidity, Stroke, Myocardial Infarction, and Deep Vein Thrombosis: A Critical Review of the Literature
01 Nov 2013-Arthritis Care and Research (Arthritis Care Res (Hoboken))-Vol. 65, Iss: 11, pp 1869-1873
TL;DR: One of the first needs of APS ACTION was to know the true aPL frequency in patients with pregnancy morbidity, stroke, myocardial infarction, and deep venous thrombosis.
Abstract: Objective
Antiphospholipid Syndrome Alliance For Clinical Trials and International Networking (APS ACTION) is an international research network devoted to conducting well-designed clinical trials in persistently antiphospholipid antibody (aPL)–positive patients. One of the first needs of APS ACTION was to know the true aPL frequency in patients with pregnancy morbidity (PM), stroke (ST), myocardial infarction (MI), and deep venous thrombosis (DVT).
Methods
The search for “aPL” and multiple keywords regarding the outcomes of interest was completed in PubMed. The median frequency for positive aPL tests (lupus anticoagulant, antibody against cardiolipin [aCL], and antibody against β2-glycoprotein I [anti-β2GPI]) was calculated for each outcome and was used to estimate the overall aPL frequency.
Results
Based on the analysis of 120 full-text papers, the overall aPL frequency was estimated as 6% for PM, 13.5% for ST, 11% for MI, and 9.5% for DVT. Limitations of the literature were that 60% of the papers were published before 2000, all 3 criteria aPL tests were performed in only 11% of the papers, 36% of papers used a low-titer aCL cutoff, anti-β2GPI cutoff was quite heterogeneous, aPL confirmation was performed in only one-fifth of papers, and the study design was retrospective in nearly half of the papers.
Conclusion
It is difficult to determine the frequency of a “clinically significant aPL profile” in patients with aPL-related clinical outcomes due to the lack of robust data. Our best estimates of the incidence of aPL-associated events should be confirmed with appropriately designed population studies.
Citations
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References
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University of New South Wales1, Hospital for Special Surgery2, Hokkaido University3, University of Utah4, University of Texas Health Science Center at San Antonio5, Utrecht University6, University of Milan7, Geneva College8, Sheba Medical Center9, University of Brescia10, National and Kapodistrian University of Athens11
TL;DR: This document appraise the existing evidence on clinical and laboratory features of APS addressed during the forum and proposes amendments to the Sapporo criteria, including definitions on features ofAPS that were not included in the updated criteria.
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"Estimated Frequency of Antiphosphol..." refers background or result in this paper
...Assessment of concomitant thrombotic risk factors is currently recognized as critical in the evaluation of aPLassociated events (2)....
[...]
...lipin antibodies (aCL), and anti– 2-glycoprotein I antibodies (anti- 2GPI) tests (2)....
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...All the papers were analyzed for the following: 1) study design (retrospective, prospective, case–control, cross-sectional, and case series); 2) number of patients, sex, and age (mean, range); 3) type of outcome; 4) number and type of aPL tests used (criteria tests versus noncriteria [2]); 5) definition of “positive criteria aPL” (low-, medium-, hightiter, or other); 6) confirmation of criteria aPL, at least 6 weeks (5) or 12 weeks (2) apart; and 7) frequency of positive aPL in the study population (defined by sex and age range)....
[...]
...Particularly for the obstetric field, the definitions of outcomes were frequently not in agreement with recent international criteria (2)....
[...]
...Such a cutoff does not allow identifying those medium- to high-titer patients who are considered as “real” aCL positive, according to the international consensus (2)....
[...]
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