1. Single or triple positivity for antiphospholipid antibodies in 'carriers' or symptomatic patients: Untangling the knot
- Author
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Noémie Resseguier, Nathalie Bardin, Véronique Veit, Laurence Camoin-Jau, Daniel Bertin, Jean-Louis Mege, Pauline Buffet Delmas, Pierre-Emmanuel Morange, Xavier Heim, Mathilde Lambert, Institut de neurophysiopathologie (INP), Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Hôpital de la Timone, Service d'hématologie, Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Unité de Médecine Aigue Polyvalente (UMAP), Centre d'études et de recherche sur les services de santé et la qualité de vie (CEReSS), Aix Marseille Université (AMU), Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), and Hôpital de la Timone [CHU - APHM] (TIMONE)
- Subjects
medicine.medical_specialty ,030204 cardiovascular system & hematology ,Asymptomatic ,anti-cardiolipin antibodies ,03 medical and health sciences ,0302 clinical medicine ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,immune system diseases ,Antiphospholipid syndrome ,Internal medicine ,mental disorders ,medicine ,Humans ,[SDV.MP.PAR]Life Sciences [q-bio]/Microbiology and Parasitology/Parasitology ,Clinical significance ,neoplasms ,ComputingMilieux_MISCELLANEOUS ,Retrospective Studies ,030203 arthritis & rheumatology ,Autoimmune disease ,[SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases ,Lupus anticoagulant ,biology ,business.industry ,antiphospholipid antibodies ,Autoantibody ,Hematology ,Antiphospholipid Syndrome ,medicine.disease ,[SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology ,3. Good health ,lupus anticoagulant ,triple positive APL ,beta 2-Glycoprotein I ,Antibodies, Anticardiolipin ,Lupus Coagulation Inhibitor ,[SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology ,Antibodies, Antiphospholipid ,biology.protein ,Anti-cardiolipin antibodies ,medicine.symptom ,Antibody ,business ,psychological phenomena and processes - Abstract
International audience; Background Although the triple positivity of antiphospholipid antibodies (aPL) is important for classifying high-risk patients, interpretation of aPL positivity, namely the lupus anticoagulant (LA), anti-cardiolipin (aCL), and anti-beta2-glycoprotein I autoantibodies (aB2GPI) remains challenging for thrombotic risk stratification. Objective To compare biological and clinical data between triple aPL- and single aCL-positive patients. Methods Of the 6500 patients assayed for aPL in daily practice within 3 years, we retrospectively analyzed data from 161 patients that were either triple aPL-positive or single aCL-positive with 5 years' follow-up for 121 of them. Results Whatever triple or single aPL positivity, we found a high prevalence of "carrier" patients (43%), which led us to question the clinical relevance of the triple aPL positivity. This result also justified the need to identify high-risk profiles. In asymptomatic patients, high risk of thrombotic events is associated with (1) two positive tests for LA or a Rosner Index >27 combined with both aCL-IgG and aB2GPI-IgG positivity, (2) persistent single aCL positivity without an associated autoimmune disease. In symptomatic patients, we demonstrated differences in the phenotype of patients and their therapeutic anticoagulation according to the number of positive aPL but we did not find differences in the number of clinical events, recurrence, or relapse, even in the absence of treatment. Conclusion This study shows that the thrombotic risk does not necessarily increase with the number of positive tests and raises the question of the therapeutic management of single aCL-positive patients.
- Published
- 2021