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Antiphospholipid Antibody

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Doruk Erkan – One of the best experts on this subject based on the ideXlab platform.

  • Primary Thrombosis Prophylaxis in Persistently Antiphospholipid Antibody-Positive Individuals: Where Do We Stand in 2018?
    Current Rheumatology Reports, 2018
    Co-Authors: Medha Barbhaiya, Doruk Erkan

    Abstract:

    Purpose of review To update our previous literature review and management recommendations on risk stratification and primary thrombosis prophylaxis in persistently Antiphospholipid Antibody (aPL)-positive individuals. Recent Findings The estimated annual thrombosis incident rate (ATIR) among aPL-positive individuals with or without systemic autoimmune disease (SAIDx) is 0 to 5.3%, probably very low (

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  • hydroxychloroquine in the primary thrombosis prophylaxis of Antiphospholipid Antibody positive patients without systemic autoimmune disease
    Lupus, 2018
    Co-Authors: Doruk Erkan, Ware D Branch, Jason S Knight, Ozan Unlu, Savino Sciascia, H M Belmont, M J Cuadrado, Emilio B Gonzalez, Imad Uthman, Rohan Willis

    Abstract:

    Objective The objective of this study was to determine the efficacy of hydroxychloroquine (HCQ) in the primary thrombosis prevention of Antiphospholipid Antibody (aPL)-positive patients with no other systemic autoimmune diseases. Methods Under the auspices of Antiphospholipid Syndrome Alliance for Clinical Trials and International Networking, a multicenter, international, randomized controlled trial (RCT) was initiated, in which persistently aPL-positive but thrombosis-free patients without systemic autoimmune diseases were randomized to receive HCQ or no treatment in addition to their standard regimen. The primary objective was the efficacy of HCQ in preventing the first thrombosis. The secondary objectives were the thrombosis incidence rate, and the effects of HCQ on aPL profile and mortality rate. Patients were risk-stratified based on antiplatelet agent use. The goal was to follow patients every 6 months for 5 years. Results We recruited 20 persistently aPL-positive patients (female: 19, mean age: 46.6 ± 9.9 years, and baseline antiplatelet medication: 14); 9/20 were randomized to HCQ. During the mean follow-up of 1.7 years, no patients developed thrombosis or a serious adverse event. The study was terminated early due to the low recruitment rate, exacerbated by the prolonged manufacturing shortage and significant price increase of HCQ in the United States. Conclusion Given that a small number of patients with a relatively short follow-up were enrolled in our RCT, and no patients developed thrombosis, we cannot accurately assess the effectiveness of HCQ for primary thrombosis prevention in persistently aPL-positive patients with no other systemic autoimmune diseases. Our experience suggests that conducting an international RCT, especially without pharmaceutical support, is an extremely challenging undertaking.

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  • The Challenge of Bleeding in Antiphospholipid Antibody-Positive Patients
    Current Rheumatology Reports, 2015
    Co-Authors: Giulia Pazzola, Stéphane Zuily, Doruk Erkan

    Abstract:

    Antiphospholipid Antibody-positive patients can develop bleeding due to capillaritis, microthrombosis, antiprothrombin antibodies, thrombocytopenia, and/or excessive antithrombotic therapy. Clinical characteristics of patients, e.g., renal impairment, elderly, or concomitant medications, are closely related to the risk of bleeding. The management of bleeding in Antiphospholipid Antibody (aPL)-positive patients is challenging due to the baseline increased risk of thrombosis. If anticoagulation is stopped, it should be restarted as soon as possible once the acute bleeding is controlled; the continuation of anticoagulation despite active bleeding may be required in selected cases. High-dose corticosteroid is the mainstay treatment for diffuse alveolar hemorrhage, lupus anticoagulant–hypoprothrombinemia syndrome, and severe thrombocytopenia; immunosuppressive drugs are also required to improve the long-term outcomes. Hydrocortisone is critical in adrenal hemorrhage patients due to concomitant adrenal insufficiency; despite bleeding, anticoagulation should be maintained as much as possible. Plasma exchange should be considered in catastrophic Antiphospholipid syndrome patients with concurrent bleeding. This article will review the causes of bleeding in aPL-positive patients as well as the management strategies.

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Michael D. Lockshin – One of the best experts on this subject based on the ideXlab platform.

  • brief report changes in Antiphospholipid Antibody titers during pregnancy effects on pregnancy outcomes
    Arthritis & Rheumatism, 2016
    Co-Authors: C Yelnik, Michael D. Lockshin, Flint T Porter, Ware D Branch, Carl A Laskin, Joan T Merrill, Marta M Guerra, Jill P Buyon, Michelle Petri, Lisa R. Sammaritano

    Abstract:

    OBJECTIVE To measure variance in Antiphospholipid Antibody (aPL) levels during pregnancy and to determine if variation affects pregnancy outcomes. METHODS We used data from the PROMISSE (Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Antibody Syndrome and Systemic Lupus Erythematosus) study, a multicenter prospective study of pregnant women with aPL and/or systemic lupus erythematosus (SLE). Antiphospholipid antibodies were considered present if any of the following were positive: anticardiolipin (aCL), anti-β2 -glycoprotein I (anti-β2 GPI) titers ≥40 IgG phospholipid (GPL) or IgM phospholipid (MPL) units, and/or lupus anticoagulant (LAC). Antiphospholipid antibodies were measured every trimester and postpartum. Adverse pregnancy outcomes were defined as fetal/neonatal death, preterm delivery (<36 weeks) due to preeclampsia or placental insufficiency, or growth restriction. RESULTS One hundred fifty-two aPL-positive patients were studied. Fifty-seven percent had clinical Antiphospholipid syndrome (APS) and 36% had SLE. IgG aPL levels were significantly lower during the second and third trimesters compared to initial screening, but IgG aCL and anti-β2 GPI remained high-positive through pregnancy in 93% of patients during the second trimester, and in 85% of patients during the third trimester. IgM aPL titers were negative in the majority of patients and decreased modestly during pregnancy among patients who were positive. LAC frequency also decreased, but 75% of patients remained positive through the second trimester. Only 4% of patients with aPL at baseline did not have aPL in either the second or third trimesters. Changes in aPL levels or aPL status were not associated with adverse pregnancy outcomes. LAC was the only aPL associated with adverse pregnancy outcomes. CONCLUSION The aPL in the cohort decreased marginally during pregnancy, and changes were not associated with pregnancy outcomes. Our results suggest that, among women with aPL and/or SLE, measuring aPL early in pregnancy is sufficient to assess risk. Repeat aPL testing through pregnancy is unnecessary.

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  • changes in Antiphospholipid Antibody titers during pregnancy data from the promisse study
    Arthritis & Rheumatism, 2016
    Co-Authors: C Yelnik, Michael D. Lockshin, Flint T Porter, Ware D Branch, Carl A Laskin, Joan T Merrill, Marta M Guerra, Jill P Buyon, Michelle Petri, Lisa R. Sammaritano

    Abstract:

    Objective
    To measure Antiphospholipid Antibody (aPL) variance during pregnancy; to determine if variation affects outcomes.

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  • Perioperative Management of Antiphospholipid Antibody-Positive Patients
    Current Rheumatology Reports, 2014
    Co-Authors: Katherine H. Saunders, Doruk Erkan, Michael D. Lockshin

    Abstract:

    Perioperative management of Antiphospholipid Antibody (aPL)-positive patients is challenging because there are limited data on which to base recommendations. This population of patients is at high risk of thrombosis at the time of surgery; it is essential that medical and surgical teams devise a plan to minimize the patient’s risk of thrombosis without increasing bleeding risk. During the perioperative period, pharmacological methods should be combined with physical methods, patients should be closely observed for thrombosis, and any deviation from the normal course should be considered a potential aPL-related event. Periods without anticoagulation should be kept to an absolute minimum for aPL-positive patients with a history of thrombosis and physicians should keep in mind that thrombosis can occur despite optimum prophylaxis.

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Lisa R. Sammaritano – One of the best experts on this subject based on the ideXlab platform.

  • brief report changes in Antiphospholipid Antibody titers during pregnancy effects on pregnancy outcomes
    Arthritis & Rheumatism, 2016
    Co-Authors: C Yelnik, Michael D. Lockshin, Flint T Porter, Ware D Branch, Carl A Laskin, Joan T Merrill, Marta M Guerra, Jill P Buyon, Michelle Petri, Lisa R. Sammaritano

    Abstract:

    OBJECTIVE To measure variance in Antiphospholipid Antibody (aPL) levels during pregnancy and to determine if variation affects pregnancy outcomes. METHODS We used data from the PROMISSE (Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Antibody Syndrome and Systemic Lupus Erythematosus) study, a multicenter prospective study of pregnant women with aPL and/or systemic lupus erythematosus (SLE). Antiphospholipid antibodies were considered present if any of the following were positive: anticardiolipin (aCL), anti-β2 -glycoprotein I (anti-β2 GPI) titers ≥40 IgG phospholipid (GPL) or IgM phospholipid (MPL) units, and/or lupus anticoagulant (LAC). Antiphospholipid antibodies were measured every trimester and postpartum. Adverse pregnancy outcomes were defined as fetal/neonatal death, preterm delivery (<36 weeks) due to preeclampsia or placental insufficiency, or growth restriction. RESULTS One hundred fifty-two aPL-positive patients were studied. Fifty-seven percent had clinical Antiphospholipid syndrome (APS) and 36% had SLE. IgG aPL levels were significantly lower during the second and third trimesters compared to initial screening, but IgG aCL and anti-β2 GPI remained high-positive through pregnancy in 93% of patients during the second trimester, and in 85% of patients during the third trimester. IgM aPL titers were negative in the majority of patients and decreased modestly during pregnancy among patients who were positive. LAC frequency also decreased, but 75% of patients remained positive through the second trimester. Only 4% of patients with aPL at baseline did not have aPL in either the second or third trimesters. Changes in aPL levels or aPL status were not associated with adverse pregnancy outcomes. LAC was the only aPL associated with adverse pregnancy outcomes. CONCLUSION The aPL in the cohort decreased marginally during pregnancy, and changes were not associated with pregnancy outcomes. Our results suggest that, among women with aPL and/or SLE, measuring aPL early in pregnancy is sufficient to assess risk. Repeat aPL testing through pregnancy is unnecessary.

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  • changes in Antiphospholipid Antibody titers during pregnancy data from the promisse study
    Arthritis & Rheumatism, 2016
    Co-Authors: C Yelnik, Michael D. Lockshin, Flint T Porter, Ware D Branch, Carl A Laskin, Joan T Merrill, Marta M Guerra, Jill P Buyon, Michelle Petri, Lisa R. Sammaritano

    Abstract:

    Objective
    To measure Antiphospholipid Antibody (aPL) variance during pregnancy; to determine if variation affects outcomes.

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  • aspirin for primary thrombosis prevention in the Antiphospholipid syndrome a randomized double blind placebo controlled trial in asymptomatic Antiphospholipid Antibody positive individuals
    Arthritis & Rheumatism, 2007
    Co-Authors: Doruk Erkan, Lisa R. Sammaritano, Michelle Petri, Roger A. Levy, Melanie J Harrison, Margaret G E Peterson, Aynur Unalparida, Veronica Silva Vilela, Yusuf Yazici, Michael D. Lockshin

    Abstract:

    Objective
    To determine the efficacy of a daily dose of 81 mg aspirin in primary thrombosis prevention in asymptomatic, persistently Antiphospholipid Antibody (aPL)–positive individuals (those with positive aPL but no vascular and/or pregnancy events).

    Methods
    The Antiphospholipid Antibody Acetylsalicylic Acid (APLASA) study was a multicenter, randomized, double-blind, placebo-controlled clinical trial in which asymptomatic, persistently aPL-positive individuals were randomized to receive a daily dose of 81 mg of aspirin or placebo. In a separate observational and parallel study, asymptomatic, persistently aPL-positive individuals who were taking aspirin or declined randomization were followed up prospectively.

    Results
    In the APLASA study, 98 individuals were randomized to receive aspirin or placebo (mean ± SD followup period 2.30 ± 0.95 years), of whom 48 received aspirin and 50 received placebo. In the observational study, 74 nonrandomized individuals were followed up prospectively (mean ± SD followup period 2.46 ± 0.76 years); 61 received aspirin and 13 did not. In the APLASA study, the acute thrombosis incidence rates were 2.75 per 100 patient-years for aspirin-treated subjects and 0 per 100 patient-years for the placebo-treated subjects (hazard ratio 1.04, 95% confidence interval 0.69–1.56) (P = 0.83). Similarly, in the observational study, the acute thrombosis incidence rates were 2.70 per 100 patient-years for aspirin-treated subjects and 0 per 100 patient-years for those not treated with aspirin. All but 1 patient with thrombosis in either study had concomitant thrombosis risk factors and/or systemic autoimmune disease at the time of thrombosis.

    Conclusion
    Our results suggest that asymptomatic, persistently aPL-positive individuals do not benefit from low-dose aspirin for primary thrombosis prophylaxis, have a low overall annual incidence rate of acute thrombosis, and develop vascular events when additional thrombosis risk factors are present.

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