The impact of antibody profile in thrombosis associated with primary antiphospholipid syndrome
Open accessAbstract
Triple positivity (TP) for antiphospholipid antibodies(aPL) may identify aPL carriers with poorer prognosis. The clinical impact of TP in primary antiphospholipid syndrome(PAPS) remains unclear and further clinical evidences are needed to validate TP as a marker of severity. The aim of this study was to evaluate the impact of TP on the clinical course of PAPS with thrombosis(t‐PAPS). We performed a retrospective analysis of a cohort of t‐PAPS patients, comparing groups of patients with TP and non‐TP profiles according to their demographic, clinical and laboratory features. We included 105 patients with t‐PAPS, the median follow‐up time of 3.7 years. Twenty‐two patients(21%) had TP; the demographic distribution, the presence of cardiovascular risk factors and the site of thrombosis were similar between TP and non‐TP patients. The frequency of thrombotic events did not differ between TP and non‐TP patients during the study period. Pregnancy morbidities were more frequent in women with t‐PAPS and TP than in those with non‐TP profile (80% vs. 52.8%, P = 0.05). Patients with t‐PAPS and TP presented, at diagnosis, higher dRVVT ratio (median R = 2.44 vs. 1.57, P < 0.0001), higher aCL titer (median = 50UI vs. 35 UI, P < 0.0001), lower C3 levels (median = 1.08 vs. 1.30 mg dL−1, P = 0.001), lower C4 levels (median = 0.22 vs. 0.25 mg dL−1, P = 0.05) and higher frequency of positive ANA test (50% vs. 20%, P = 0.008) than patients with t‐PAPS and non‐TP. Lower‐than‐normal levels of C3 was independently associated with TP (OR = 5.1, P = 0.02). The presence of TP in patients with t‐PAPS was associated with immune derangement, with no effect on the clinical course of the disease.
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aPL profiling also involves consideration of antibody titers since higher titers are associated with higher risk.
“aPL profiling also involves consideration of antibody titers since higher titers are associated with higher risk [7,8,30,31].”
From Triple-positive antiphospholipid syndrome does not guarantee positivity in each lupus anticoagulant assay (2023) · cites this paper as [31]
The Methods define persistent aPL positivity partly by moderate-to-high antibody titers, so the paper supports considering titers when assessing aPL status. The Results report higher IgG aCL titers in the triple-positive group, but the Discussion says new thrombotic events were not related to triple positivity and that the clinical significance of the higher antibody levels remains undetermined. It does not establish that higher titers confer higher risk. (LLM, conf=0.84)
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Cites
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BackgroundClinical course of high‐risk patients diagnosed with antiphospholipid syndrome
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“This finding was not expected because previous clinical studies have shown that TP confers higher risk for the development of thrombosis and recurrent thrombotic events.(4,22,23) We believe that the risk of thrombosis in APS may not be attributed solely to the aPL profile.”
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“This finding was not expected because previous clinical studies have shown that TP confers higher risk for the development of thrombosis and recurrent thrombotic events.(4,22,23) We believe that the risk of thrombosis in APS may not be attributed solely to the aPL profile.”
ResultGAPSS: the Global Anti-Phospholipid Syndrome Score
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Cited by
Sorted by citations
Moore, G. W., Foxton, E., Platton, S., Yartey, N., White, D., & MacDonald, S. G. (2023) · Journal of Thrombosis and Haemostasis · doi:10.1016/j.jtha.2023.08.009 · Cited by 6 · see citing works
- Authors
- da Silva Saraiva, S., de Moraes Mazetto, B., Quinteiro Tobaldine, L., Pereira Colella, M., Vinícius De Paula, E., Annichinno‐Bizzachi, J., & Andrade Orsi, F.
- Affiliations
- Thrombosis and Haemostasis Unit, Hematology and Hemotherapy Center University of Campinas, Rua Carlos Chagas, 480. Cidade Universitária “ZeferinoVaz” CEP: 13083‐970 Campinas SP Brazil
- Universidade Estadual de Campinas (UNICAMP) (BR)
- Venue
- American Journal of Hematology
- Publisher
- Wiley
- Published
- 2017-08-17
- Volume
- 92
- Issue
- 11
- Pages
- 1163-1169
- ISSN
- 0361-8609 (ISSN-L)
- 1096-8652
- OpenAlex
- W2741260688
- Cited by
- 18
- References
- 9
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 3 · 2022: 3 · 2019: 3 · 2018: 4
- FWCI
- 1.67
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- American Journal of Hematology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Science and Technology in Blood (INCT do Sangue)
- National Counsel of Technological and Scientific Development, Brazil
- Topics
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Vasculitis and related conditions
- Keywords
- primary antiphospholipid syndrome, thrombosis, triple positivity, antiphospholipid antibodies, C3 complement level, C4 complement level, anticardiolipin antibodies, antinuclear antibodies, pregnancy morbidity, disease severity
- MeSH terms
- Adult, Autoantibodies, Complement C3, Complement C4, Female, Follow-Up Studies, Humans, Male, Middle Aged, Pregnancy, Pregnancy Complications, Retrospective Studies, Risk Factors, Thrombosis, Biomarkers, Comorbidity, Antiphospholipid Syndrome, Antibodies, Antiphospholipid, Young Adult
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