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

Andrew S. Dunn; Peter Kaboli; Thorvardur Halfdanarson; Happy Chan; Rod Hubert; Seth Rosen; Richard H. White

doi:10.1160/TH04-11-0756

Thrombosis and Haemostasis, Table of Contents

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

¹Division of General Medicine, Mount Sinai School of Medicine, New York, New York, USA

,

Peter Kaboli

²Division of General Medicine, Iowa City VA Medical Center and the University of Iowa Carver College of Medicine, Iowa City, Iowa, USA

,

Thorvardur Halfdanarson

³Division of Hematology/Oncology, Mayo Clinic, Rochester, Minnesota, USA

,

Happy Chan

⁴Division of General Medicine, University of California, Davis, Sacramento, California, USA

,

Rod Hubert

⁴Division of General Medicine, University of California, Davis, Sacramento, California, USA

,

Seth Rosen

²Division of General Medicine, Iowa City VA Medical Center and the University of Iowa Carver College of Medicine, Iowa City, Iowa, USA

,

Richard H. White

⁴Division of General Medicine, University of California, Davis, Sacramento, California, USA

› Author Affiliations

Abstract

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

Full Text

References

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