CHICAGO—Antiphospholipid antibody syndrome (APS) mainly affects young women, but can also affect men. APS patients test positive for multiple antibodies, including lupus anticoagulant (LAC), anti-cardiolipin and/or anti-beta2-glycoprotein I. These antibodies are diagnostic of APS, and they place the patient at increased risk for thrombosis and, in women, pregnancy morbidity. Women with LAC or those who are “triple positive” (i.e., have LAC, medium- to high-titer anti-cardiolipin and anti-beta 2-glycoprotien I antibodies) have worse prognoses for pregnancy morbidity.
D. Ware Branch, MD, a maternal-fetal medicine specialist at the University of Utah, Salt Lake City, began the APS session at the 2018 ACR/ARHP Annual Meeting with a discussion of the implications of APS in the field of obstetrics. He noted recurrent early miscarriage (embryonic loss prior to 10 weeks of gestation) is probably the most common clinical criterion for the diagnosis of APS. Women with the diagnosis have been the focus of several treatment trials.
Dr. Branch reviewed the data from a half dozen trials representing approximately 500 patients. He and others have been skeptical of conclusions based on these trials because of the variety and number of antiphospholipid antibody tests used, the definition of positive results, the methods used to establish thresholds for positive results, the lack of confirmatory testing and the nature of the study designs. Many experts would argue some of the patients who were low positive for antiphospholipid antibodies should not have been considered to have APS. Moreover, live birth and miscarriage rates in the treatment arms varied considerably.