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Estimated Frequency of Antiphospholipid Antibodies in Patients With Pregnancy Morbidity, Stroke, Myocardial Infarction, and Deep Vein Thrombosis: A Critical Review of the Literature
Author(s) -
Andreoli Laura,
Chighizola Cecilia B.,
Banzato Alessandra,
PonsEstel Guillermo J.,
Jesus Guilherme Ramire,
Erkan Doruk
Publication year - 2013
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.22066
Subject(s) - medicine , antiphospholipid syndrome , lupus anticoagulant , stroke (engine) , thrombosis , myocardial infarction , deep vein , population , clinical trial , cardiology , mechanical engineering , environmental health , engineering
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 β 2 ‐glycoprotein I [anti‐β 2 GPI]) 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‐β 2 GPI 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.