PoM No 2, 2014

Publication of the Month

February 02/14: A review of studies of anti-phospholipid antibodies and related clinical conditions proves limited

 

Key messages:

  • Estimates of the frequency of clinically-significant anti-phospholipid profile in patients with related clinical outcomes are difficult and loose because of the unavailability of good data.
  • To understand these conditions, well-designed population studies are needed.

 

Andreoli L, Chighizola CB, Banzato A, Pons-Estel GJ, de Jesus GR, Erkan D
Estimated Frequency of Antiphospholipid Antibodies in Patients with Pregnancy Morbidity, Stroke, Myocardial Infarction, and Deep Vein Thrombosis: A Critical Review of the Literature.
Arthritis Care Res 2013; 65: 1869-1873

 

Background: The Antiphospholipid Syndrome Alliance For Clinical Trials and International Networking (APS ACTION) is an international research network created in 2010 specifically to conduct well-designed, large-scale multicentre clinical trials in persistently anti-phospholipid antibody (aPL)-positive patients. One of the first needs of the group was to better understand the frequency of aPL in populations with pregnancy morbidity (PM), stroke (ST), myocardial infarction (MI) and deep venous thrombosis (DVT).

 

Summary: APS ACTION undertook an extensive literature search in PubMed, calculating the median frequency of positive aPL tests (anti-cardiolipin IgG/IgM, anti-β2-glycoprotein l IgG/IgM and lupus anticoagulant) in various conditions. However, they found that the results could only be estimated due to the limitations of published studies ; namely that most (60%) of the papers were more than ten years old, very few papers (11%) used all 3 criteria aPL tests, nearly half of the studies were retrospective, confirmation of positive aPL was performed in only one-fifth of papers, methods of reporting the cut-off for β2-GPl antibodies was quite heterogeneous and a low-titer cut-off for aCL (,20units) was used in most studies.

 

Conclusions: Best estimates for the frequency of aPL are 6% for PM, 13.5% for ST, 11% for MI and 9.5% for DVT.

 

Comment: This paper points out both the relatively high frequency of anti-phospholipid antibodies in clinically highly-significant disorders as well as the great paucity of robust data on their incidence and associations. It is to be hoped that further outputs from this group will provide encouragement for the undertaking and publication of studies which will help to clarify the laboratory and clinical relationships in this very important area and that this will eventually lead to useful guidelines and improved outcomes for those affected patients

 

 

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As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.