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Thromb Haemost 2005; 94(03): 548-554
DOI: 10.1160/TH04-11-0756
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

Do patients followed in anticoagulation clinics for antiphospholipid syndrome meet criteria for the disorder?

Andrew S. Dunn
1   Division of General Medicine, Mount Sinai School of Medicine, New York, New York, USA
,
Peter Kaboli
2   Division of General Medicine, Iowa City VA Medical Center and the University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
,
Thorvardur Halfdanarson
3   Division of Hematology/Oncology, Mayo Clinic, Rochester, Minnesota, USA
,
Happy Chan
4   Division of General Medicine, University of California, Davis, Sacramento, California, USA
,
Rod Hubert
4   Division of General Medicine, University of California, Davis, Sacramento, California, USA
,
Seth Rosen
2   Division of General Medicine, Iowa City VA Medical Center and the University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
,
Richard H. White
4   Division of General Medicine, University of California, Davis, Sacramento, California, USA
› Author Affiliations Financial support: The development of the web site used for data collection was funded by an unrestricted gift from AstraZeneca Pharmaceuticals. No other funding was provided for performance of the study. Presented at the National Meeting of the Association of Rheumatology Healthcare Professionals. San Antonio, Texas, U.S.A. October 2004.
Further Information

Publication History

Received: 23 November 2004

Accepted after major revision: 21 June 2005

Publication Date:
07 December 2017 (online)

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Summary

Although specific criteria for diagnosing the antiphospholipid syndrome (APS) exist (the Sapporo Criteria), most physicians are not aware these include repeat testing and documentation of either a lupus anticoagulant or medium to high levels of anticardiolipin antibody. Incorrect diagnosis of APS may result in unnecessary long-term anticoagulation. The purpose of this study was to determine the clinical and serological characteristics of patients being treated for APS and concordance with published criteria. This cross-sectional study identified APS patients who were being treated with warfarin at one of three universitybased anticoagulation clinics. Levels of anticardiolipin antibody were classified as low-positive if abnormal but <40 GPL/MPL units and medium/high-positive if ≥40 units. Strength of meeting Sapporo criteria was graded as definite, possible, and not meeting criteria. Of 103 cases, 97 had clinical and laboratory data available. Only 10 cases (10%, 95% Confidence Interval 5 - 19) met criteria for definite APS, 16 (16%, 10 - 26) had a possible diagnosis, and 71 (73%, 63 - 81) did not meet criteria. Of 70 cases that had abnormal anticardiolipin antibody results, only 32 (46%, 34 - 58) had medium/high-positive levels. Repeat laboratory testing was performed in only 49 cases (51%, 40 - 61). We conclude that few patients treated forAPS met Sapporo criteria. Abnormal levels of anticardiolipin antibody were frequently in the low-positive range, and repeat testing was often absent. A quality improvement program that includes review of cases referred for chronic anticoagulation care is recommended to ensure appropriate testing and treatment of patients with suspected APS.

Keywords

Antiphospholipid antibody syndrome - lupus anticoagulant - anticardiolipin antibody - anticoagulation - diagnosis
 

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