TY - JOUR
T1 - Do patients followed in anticoagulation clinics for antiphospholipid syndrome meet criteria for the disorder?
AU - Dunn, Andrew S.
AU - Kaboli, Peter
AU - Halfdanarson, Thorvardur
AU - Chan, Happy
AU - Hubert, Rod
AU - Rosen, Seth
AU - White, Richard H.
PY - 2005/9
Y1 - 2005/9
N2 - 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 anti-cardiolipin antibody. Incorrect diagnosis ofAPS 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 university-based 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.
AB - 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 anti-cardiolipin antibody. Incorrect diagnosis ofAPS 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 university-based 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.
KW - Anticardiolipin antibody
KW - Anticoagulation
KW - Antiphospholipid antibody syndrome
KW - Diagnosis
KW - Lupus anticoagulant
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U2 - 10.1160/TH04-11-0756
DO - 10.1160/TH04-11-0756
M3 - Review article
C2 - 16268471
AN - SCOPUS:24944472305
SN - 0340-6245
VL - 94
SP - 548
EP - 554
JO - Thrombosis and Haemostasis
JF - Thrombosis and Haemostasis
IS - 3
ER -