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

Journal: Thrombosis and Haemostasis
ISSN: 0340-6245
DOI: http://dx.doi.org/10.1160/TH04-11-0756
Issue: 2005: 94/3 (Sep) pp. 469-691
Pages: 548-554

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

Andrew S. Dunn1 , Peter Kaboli2 , Thorvardur Halfdanarson3 , Happy Chan4 , Rod Hubert4 , Seth Rosen 2 , Richard H. White4
1 Division of General Medicine, Mount Sinai School of Medicine, New York, New York, USA 2 Division of General Medicine, Iowa City VA Medical Center and the University of Iowa Carver College of Medicine, Iowa City, Iowa, USA 3 Division of Hematology/Onco

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 meet ing 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.

DOI

http://dx.doi.org/10.1160/TH04-11-0756