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Martinuzzo ME, Forastiero R, Duboscq C, Barrera LH, López MS, Ceresetto J, Penchasky D, Oyhamburu J. False-positive lupus anticoagulant results by DRVVT in the presence of rivaroxaban even at low plasma concentrations. Int J Lab Hematol 2018; 40:e99-e101. [DOI: 10.1111/ijlh.12865] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M. E. Martinuzzo
- Laboratorio Central; Hospital Italiano de Buenos Aires; CABA Argentina
- Instituto Universitario del Hospital Italiano; Buenos Aires, CABA Argentina
| | | | - C. Duboscq
- Servicio de Hematología del Hospital Británico; Buenos Aires, CABA Argentina
| | - L. H. Barrera
- Laboratorio Central; Hospital Italiano de Buenos Aires; CABA Argentina
- Instituto Universitario del Hospital Italiano; Buenos Aires, CABA Argentina
| | - M. S. López
- Laboratorio Central; Hospital Italiano de Buenos Aires; CABA Argentina
- Instituto Universitario del Hospital Italiano; Buenos Aires, CABA Argentina
| | - J. Ceresetto
- Servicio de Hematología del Hospital Británico; Buenos Aires, CABA Argentina
| | - D. Penchasky
- Servicio de Hematología del Hospital Italiano de Buenos Aires; Ciudad Autónoma de Buenos Aires Argentina
| | - J. Oyhamburu
- Laboratorio Central; Hospital Italiano de Buenos Aires; CABA Argentina
- Instituto Universitario del Hospital Italiano; Buenos Aires, CABA Argentina
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Adamczuk Y, Varela ML, Forastiero R, Martinuzzo M, Cerrato G, Pombo G, Carreras LO. Factor V Leiden and Prothrombin G 20210A Variant Are Risk Factors for Venous Thromboembolism in the Argentinean Population. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1613845] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Martinuzzo M, Bocassi A, Fressart M, Forastiero R, de Larrañaga G. Heparin-platelet Factor 4 Induced Antibodies in Patients with either Autoimmune or Alloimmune Antiphospholipid Antibodies. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1613220] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Amengual O, Forastiero R, Sugiura-Ogasawara M, Otomo K, Oku K, Favas C, Delgado Alves J, Žigon P, Ambrožič A, Tomšič M, Ruiz-Arruza I, Ruiz-Irastorza G, Bertolaccini ML, Norman GL, Shums Z, Arai J, Murashima A, Tebo AE, Gerosa M, Meroni PL, Rodriguez-Pintó I, Cervera R, Swadzba J, Musial J, Atsumi T. Evaluation of phosphatidylserine-dependent antiprothrombin antibody testing for the diagnosis of antiphospholipid syndrome: results of an international multicentre study. Lupus 2016; 26:266-276. [PMID: 27510605 DOI: 10.1177/0961203316660203] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective A task force of scientists at the International Congress on Antiphospholipid Antibodies recognized that phosphatidylserine-dependent antiprothrombin antibodies (aPS/PT) might contribute to a better identification of antiphospholipid syndrome (APS). Accordingly, initial and replication retrospective, cross-sectional multicentre studies were conducted to ascertain the value of aPS/PT for APS diagnosis. Methods In the initial study (eight centres, seven countries), clinical/laboratory data were retrospectively collected. Serum/plasma samples were tested for IgG aPS/PT at Inova Diagnostics (Inova) using two ELISA kits. A replication study (five centres, five countries) was carried out afterwards. Results In the initial study ( n = 247), a moderate agreement between the IgG aPS/PT Inova and MBL ELISA kits was observed ( k = 0.598). IgG aPS/PT were more prevalent in APS patients (51%) than in those without (9%), OR 10.8, 95% CI (4.0-29.3), p < 0.0001. Sensitivity, specificity, positive (LR+) and negative (LR-) likelihood ratio of IgG aPS/PT for APS diagnosis were 51%, 91%, 5.9 and 0.5, respectively. In the replication study ( n = 214), a moderate/substantial agreement between the IgG aPS/PT results obtained with both ELISA kits was observed ( k = 0.630). IgG aPS/PT were more prevalent in APS patients (47%) than in those without (12%), OR 6.4, 95% CI (2.6-16), p < 0.0001. Sensitivity, specificity, LR + and LR- for APS diagnosis were 47%, 88%, 3.9 and 0.6, respectively. Conclusions IgG aPS/PT detection is an easily performed laboratory parameter that might contribute to a better and more complete identification of patients with APS.
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Affiliation(s)
- O Amengual
- 1 Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - R Forastiero
- 2 Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET, Departamento de Fisiologia, Hemostasia y Trombosis, Buenos Aires, Argentina
| | - M Sugiura-Ogasawara
- 3 Department of Obstetrics and Gynecology, Nagoya City University, Graduated School of Medical Sciences, Nagoya, Japan
| | - K Otomo
- 1 Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - K Oku
- 1 Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - C Favas
- 4 Department of Medicine IV, Fernando Fonseca Hospital, Amadora and CEDOC/NOVA Medical School, Lisbon, Portugal
| | - J Delgado Alves
- 4 Department of Medicine IV, Fernando Fonseca Hospital, Amadora and CEDOC/NOVA Medical School, Lisbon, Portugal
| | - P Žigon
- 5 Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - A Ambrožič
- 5 Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - M Tomšič
- 5 Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - I Ruiz-Arruza
- 6 Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, University of The Basque Country, Spain
| | - G Ruiz-Irastorza
- 6 Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, University of The Basque Country, Spain
| | - M L Bertolaccini
- 7 Academic Department of Vascular Surgery, Cardiovascular Division, King's College London, UK
| | - G L Norman
- 8 Inova Diagnostics Inc., San Diego, CA, USA
| | - Z Shums
- 8 Inova Diagnostics Inc., San Diego, CA, USA
| | - J Arai
- 9 Medical and Biological Laboratories, Co. Ltd, Nagano, Japan
| | - A Murashima
- 10 Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - A E Tebo
- 11 Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City, UT, USA
| | - M Gerosa
- 12 Department of Clinical Sciences and Community Health, Istituto Auxologico Italiano, University of Milan, Milan, Italy
| | - P L Meroni
- 12 Department of Clinical Sciences and Community Health, Istituto Auxologico Italiano, University of Milan, Milan, Italy
| | - I Rodriguez-Pintó
- 13 Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - R Cervera
- 13 Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - J Swadzba
- 14 Department of Medicine Jagiellonian University, Cracow, Poland
| | - J Musial
- 14 Department of Medicine Jagiellonian University, Cracow, Poland
| | - T Atsumi
- 1 Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Amengual O, Forastiero R, Sugiura-Ogasawara M, Otomo K, Kenji O, Favas C, Delgado Alves J, Žigon P, Ambrožič A, Tomšič M, Ruiz Arruza I, Ruiz Irastorza G, Bertolaccini M, Norman G, Shums Z, Jiro A, Murashima A, Tebo A, Gerosa M, Meroni P, Rodriguez-Pintό I, Cervera R, Swadzba J, Musial J, Atsumi T. OP0223 Significance of IGG Phosphatidylserine-Dependent Antiprothrombin Antibody Testing for the Diagnosis of Antiphospholipid Syndrome: Results from the Initial and Validation International Multi-Centre Studies. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
The antiphospholipid syndrome (APS) is characterized by the presence of aPL and thrombosis and/or pregnancy morbidity. The last APS laboratory classification criteria include the presence of at least one of the antiphospholipid antibodies (aPL) [lupus anticoagulant (LA), anticardiolipin (aCL) and/or anti-β2 glycoprotein I antibodies (aβ2GPI)] and introduced the concept of subclassification of APS patients into two different categories of aPL assay positivity (combination or single aPL). Several studies have recently shown that the risk for thrombosis increases with each additional aPL detected. We found that the presence of IgG antibodies to β2GPI and/or prothrombin increased thrombotic risk in patients with LA and/or aCLin a prospective study. Various studies have recently demonstrated that patients with triple positivity (LA, aCL and aβ2GPI) are at the highest risk for venous and arterial thrombosis and for obstetric complications. In retrospective but also in prospective studies the rate of thrombotic recurrence was high in subjects with triple positivity even while on anticoagulant therapy. In addition, the occurrence of a first thrombotic event in asymptomatic carriers of triple positivity was higher than in those with single aPL positivity. The inclusion of the detection of antibodies against domain I of β2GPI and/or antibodies to prothrombin would probably help to further identify more clinically relevant aPL. Based on the last findings, there are some proposals to consider only patients with triple positivity as definite APS (thrombotic and obstetric).
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Affiliation(s)
- R Forastiero
- Department of Physiology, Thrombosis and Hemostasis, FavaloroUniversity, Buenos Aires, Argentina
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Amengual O, Forastiero R, Sugiura-Ogasawara M, Oku K, Otomo K, Alves J, Favas C, Žigon P, Ambrožič A, Tomšič M, Ruiz-Irastorza G, Ruiz-Arruza I, Bertolaccini M, Norman G, Shums Z, Arai J, Atsumi T. SAT0202 International Multi-Centre Study to Evaluate the Clinical Significance of Phosphatidylserine-Dependent Antiprothrombin Antibodies for the Diagnosis of Antiphospholipid Syndrome. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Forastiero R, Papalardo E, Watkins M, Nguyen H, Quirbach C, Jaskal K, Kast M, Teodorescu M, Lakos G, Binder W, Shums Z, Nelson V, Norman G, Puig J, Cox A, Vandam W, Hardy J, Pierangeli S. Evaluation of different immunoassays for the detection of antiphospholipid antibodies: Report of a wet workshop during the 13th International Congress on Antiphospholipid Antibodies. Clin Chim Acta 2014; 428:99-105. [DOI: 10.1016/j.cca.2013.11.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 11/05/2013] [Accepted: 11/06/2013] [Indexed: 01/04/2023]
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Arnaud L, Mathian A, Miyara M, Devilliers H, Lambert M, Forastiero R, Wahl D, Amoura Z. Prévention primaire par aspirine de la thrombose chez les patients porteurs d’anticorps anti-phospholipides : une méta-analyse des données de la littérature. Rev Med Interne 2011. [DOI: 10.1016/j.revmed.2011.10.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bertolaccini ML, Amengual O, Atsumi T, Binder WL, de Laat B, Forastiero R, Kutteh WH, Lambert M, Matsubayashi H, Murthy V, Petri M, Rand JH, Sanmarco M, Tebo AE, Pierangeli SS. 'Non-criteria' aPL tests: report of a task force and preconference workshop at the 13th International Congress on Antiphospholipid Antibodies, Galveston, TX, USA, April 2010. Lupus 2011; 20:191-205. [PMID: 21303836 DOI: 10.1177/0961203310397082] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Abstract: Current classification criteria for definite APS recommend the use of one or more of three positive standardized laboratory assays, including anticardiolipin antibodies (aCL), lupus anticoagulant (LA), and antibodies directed to β(2)glycoprotein I (anti-β(2)GPI) to detect antiphospholipid antibodies (aPL) in the presence of at least one of the two major clinical manifestations (i.e., thrombosis or pregnancy morbidity) of the syndrome. Several other autoantibodies shown to be directed to phospholipids and/or their complexes with phospholipids and/or to proteins of the coagulation cascade, as well as a mechanistic test for resistance to annexin A5 anticoagulant activity, have been proposed to be relevant to APS. A task force of worldwide scientists in the field discussed and analyzed critical questions related to 'non-criteria' aPL tests in an evidence-based manner during the 13th International Congress on Antiphospholipid Antibodies (APLA 2010, 13-16 April 2010, Galveston, Texas, USA). This report summarizes the findings, conclusions, and recommendations of this task force.
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Affiliation(s)
- M L Bertolaccini
- Lupus Research Unit, The Rayne Institute, King's College London School of Medicine, London, UK.
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Forastiero R, Martinuzzo M, de Larrañaga G, Vega-Ostertag M, Pierangeli S. Anti-β2glycoprotein I antibodies from leprosy patients do not show thrombogenic effects in an in vivo animal model. J Thromb Haemost 2011; 9:859-61. [PMID: 21251199 DOI: 10.1111/j.1538-7836.2011.04197.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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De Laat B, Derksen RHWM, Reber G, Musial J, Swadzba J, Bozic B, Cucnik S, Regnault V, Forastiero R, Woodhams BJ, De Groot PG. An international multicentre-laboratory evaluation of a new assay to detect specifically lupus anticoagulants dependent on the presence of anti-beta2-glycoprotein autoantibodies. J Thromb Haemost 2011; 9:149-53. [PMID: 20874780 DOI: 10.1111/j.1538-7836.2010.04068.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Antiphospholipid syndrome (APS) is diagnosed by the simultaneous presence of vascular thrombosis and/or pregnancy morbidity and detection of antiphospholipid antibodies in plasma. OBJECTIVES We have shown that prolongation of clotting time by anti-beta2-glycoprotein I (beta2GPI) antibodies correlates better with thrombosis than a positive classic lupus anticoagulant (LAC) assay in a single center study. To confirm or falsify this finding we have conducted a multicenter study. METHODS AND RESULTS In 325 LAC-positive samples, we found that the beta2GPI-dependent LAC correlated 2.0 times better with thrombosis than the classic LAC assay. Although significant, this was a minimal improvement compared with the 'classic' LAC. It was published that calcium influences the behavior of anti-beta2GPI antibodies in coagulation assays. To investigate whether calcium plays a role in the present study, we divided the patient population into two groups: (i) blood was collected in 0.109 m sodium citrate and (ii) blood was drawn in 0.129 m sodium citrate as anticoagulant. We found that a positive result with the beta2GPI-dependent LAC assay correlated better with thrombosis [odds ratio (OR): 3.3, 95% confidence interval (CI) 1.9-5.8] when 0.109 m sodium citrate was used compared with 0.129 m sodium citrate (OR: 0.4, 95% CI 0.1-1.1). CONCLUSION We were able to confirm in an international multicenter study that a positive result in a beta2GPI-dependent LAC assay correlates better with thrombosis than the classic LAC assay, but that the assay needs further study as it is sensitive to external factors such as the sodium citrate concentration used as anticoagulant in the test sample.
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Affiliation(s)
- B De Laat
- Department of Clinical Chemistry and Hematology, University Medical Center, Utrecht, the Netherlands.
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Abstract
Antiphospholipid syndrome (APS) is a clinical autoimmune disorder characterised by thrombosis, venous or arterial, and recurrent pregnancy morbidity in association with the persistence of antiphospholipid antibodies (aPL). The clinical variety of aPL ranges from asymptomatic individuals to those with multiple organ thromboses and failure developing over a short period, also known as catastrophic APS. An increasing number of phospholipid-binding proteins with crucial functions in the regulation of blood coagulation and fibrinolysis are targeted by APS-related autoantibodies. Disruption of fibrinolysis is one of the proposed pathophysiological mechanisms for the APS. There are some experimental data for an association between impaired overall fibrinolytic activity and autoimmune aPL; however, evidence is still inconclusive and more studies are needed in this area. In this article, we review the evidence by which aPL may disturb fibrinolysis.
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Affiliation(s)
- R Forastiero
- Division of Haematology, Thrombosis and Haemostasis, University Hospital, Favaloro University, Favaloro Foundation, Buenos Aires, Argentina
| | - M Martinuzzo
- Division of Haematology, Thrombosis and Haemostasis, University Hospital, Favaloro University, Favaloro Foundation, Buenos Aires, Argentina
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Affiliation(s)
- R Forastiero
- Division of Hematology, Thrombosis and Hemostasis, Institute of Cardiology and Cardiovascular Surgery, Favaloro Foundation, Favaloro University, Buenos Aires, Argentina.
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Martinuzzo M, Iglesias Varela ML, Adamczuk Y, Broze GJ, Forastiero R. Antiphospholipid antibodies and antibodies to tissue factor pathway inhibitor in women with implantation failures or early and late pregnancy losses. J Thromb Haemost 2005; 3:2587-9. [PMID: 16241962 DOI: 10.1111/j.1538-7836.2005.01612.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Forastiero R, Martinuzzo M, Pombo G, Puente D, Rossi A, Celebrin L, Bonaccorso S, Aversa L. A prospective study of antibodies to beta2-glycoprotein I and prothrombin, and risk of thrombosis. J Thromb Haemost 2005; 3:1231-8. [PMID: 15946213 DOI: 10.1111/j.1538-7836.2005.01295.x] [Citation(s) in RCA: 137] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Antiphospholipid syndrome (APS) is a clinical autoimmune disorder characterized by thrombosis/pregnancy morbidity associated with the persistence of lupus anticoagulant (LA) and/or anticardiolipin (aCL) antibodies. We assessed the contribution of antibodies to beta2-glycoprotein I (anti-beta2GPI) and prothrombin (anti-PT) to the thrombotic risk in a cohort of 194 consecutive patients with persistent LA and/or aCL. Median follow-up was 45 months. A total of 39 patients (20.1%) had one documented episode of thrombosis during follow-up. Eleven of these patients had no previous thrombosis before enrollment in the study and 28 had recurrences of thrombosis. There were 21 venous and 18 arterial thrombotic events and the overall incidence of thrombosis was 5.6% per patient-year. After multivariate analysis, the male sex (P = 0.025), a previous thrombosis (P < 0.01), the presence of anti-beta2GPI (P = 0.001), and the presence of anti-PT (P = 0.03) remained as independent risk factors for recurrent thrombosis. Only IgG anti-beta2GPI and anti-PT were associated with an increased risk of thrombosis (P < 0.01 and P = 0.005). Patients testing positive for anti-beta2GPI had a higher rate of thrombosis than did antiphospholipid patients without anti-beta2GPI (8.0% vs. 3.1% per patient-year). Similarly, a higher rate of thrombosis was found in patients with positive anti-PT compared with patients without anti-PT (8.6% vs. 3.5% per patient-year). Considering only the group of 142 LA positive patients, the highest incidence of thrombosis was found in LA patients positive for both anti-beta2GPI and anti-PT (8.4% per patient-year). In conclusion, the presence of IgG anti-beta2GPI and anti-PT in patients with LA and/or aCL and mainly in those with LA predicts a higher risk of thromboembolic events.
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Affiliation(s)
- R Forastiero
- Division of Hematology, Thrombosis and Hemostasis, Institute of Cardiology and Cardiovascular Surgery, Favaloro Foundation, Favaloro University, Buenos Aires, Argentina.
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Lockshin M, Tenedios F, Petri M, McCarty G, Forastiero R, Krilis S, Tincani A, Erkan D, Khamashta MA, Shoenfeld Y. Cardiac disease in the antiphospholipid syndrome: recommendations for treatment. Committee consensus report. Lupus 2003; 12:518-23. [PMID: 12892391 DOI: 10.1191/0961203303lu391oa] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Committee reviewed cardiac involvement in the antiphospholipid antibody syndrome. The Committee's recommendations are: Valve abnormalities: anticoagulation is recommended for symptomatic patients with valvulopathy. Prophylactic antiplatelet therapy may be appropriate for asymptomatic patients (recommended by 13/17 experts in an independent review). Committee members disagreed whether corticosteroid therapy is helpful, but agree that distinguishing among presumptive valvulitis (valve thickening on echocardiogram), valve deformity and vegetations is important, as treatment implications may differ. Occlusive arterial disease (angina, myocardial infarction): the Committee recommends aggressive treatment of all risk factors for atherosclerosis (hypertension, hypercholesterolaemia, smoking) and liberal use of folic acid, B vitamins and cholesterol-lowering drugs (preferably statins). Hydroxychloroquine for cardiac protection in APS patients may be considered. The Committee also recommends warfarin anticoagulation for those who have suffered thrombosis in the absence of atherosclerosis, but recognizes that developing data may support the use of antiplatelet agents instead. Intracardiac thrombi: the Committee recommends intensive warfarin anticoagulation, and consultation with cardiac surgeons when appropriate. Ventricular dysfunction: the Committee has no recommendations on this aspect of cardiac disease. Pulmonary hypertension: the Committee recommends intensive anticoagulation with warfarin and clinical trials of bosentan, epoprostenol and other new agents.
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Affiliation(s)
- M Lockshin
- Hospital for Special Surgery, Barbara Volcker Center for Women and Rheumatic Diseases, New York, NY 10021, USA.
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Forastiero R, Martinuzzo M, De Larrañaga G, Broze GJ. Autoantibodies to TFPI are associated with definite APS but not with infection-related aPL. J Thromb Haemost 2003. [DOI: 10.1111/j.1538-7836.2003.tb05838.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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de Larrañaga G, Martinuzzo M, Bocassi A, Fressart MM, Forastiero R. Heparin-platelet factor 4 induced antibodies in patients with either autoimmune or alloimmune antiphospholipid antibodies. Thromb Haemost 2002; 88:371-3. [PMID: 12195721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Forastiero R, Martinuzzo M, Carreras LO. Imbalance towards Th2-type response in patients with definite primary antiphospholipid syndrome. Thromb Haemost 2001; 86:934-5. [PMID: 11583333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Forastiero R, Martinuzzo M, Adamczuk Y, Varela ML, Pombo G, Carreras LO. The combination of thrombophilic genotypes is associated with definite antiphospholipid syndrome. Haematologica 2001; 86:735-41. [PMID: 11454529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Thrombosis and pregnancy morbidity are clinical features of the definite antiphospholipid syndrome (APS). These clinical complications are also associated with the presence of inherited thrombophilias. Interactions between acquired and genetic risk factors are becoming increasingly related to a higher thrombotic risk. The aim of our study was to determine the prevalence of four common gene polymorphisms in patients with antiphospholipid antibodies (aPL). DESIGN AND METHODS A series of 105 consecutive unselected patients with aPL grouped as having APS (n= 69) and not having APS (n= 36) was studied. A control group of 200 healthy subjects was also investigated for the presence of factor V Leiden (FVL), the 20210A allele of the prothrombin (PT-20210A) gene, the thermolabile variant (677TT) of methylenetetrahydrofolate reductase (MTHFR), and the 4G/4G genotype of the plasminogen activator inhibitor (PAI-1) promoter. RESULTS Two patients who belong to the APS group carried the FVL while PT-20210A was found in 6 patients with APS (8.7%) and in 1 of the non-APS group (2.8%). The prevalence of FVL was similar to that found in the control group whereas PT-20210A was significantly more frequent in APS patients than in normal controls (2.0%, p=0.02). The MTHFR-677TT was found in 22.0%, 15.1% and 13.0%, and the PAI-1 (4G/4G) in 27.5%, 22.8% and 23.5% of APS, non-APS patients and normal controls, respectively. Furthermore, combinations of PT-20210A or FVL with PAI-1 (4G/4G) were significantly more frequent in APS patients (5.8%) than in normal controls (0.5%, p=0.016). This difference was not found between non-APS patients and normal subjects. INTERPRETATION AND CONCLUSIONS Present data indicate that testing for heritable thrombophilia would be important to identify aPL subjects with an increased risk of developing APS.
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Affiliation(s)
- R Forastiero
- Department of Haematology, Thrombosis and Haemostasis, Favaloro University, Buenos Aires, Argentina
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Adamczuk Y, Iglesias Varela ML, Forastiero R, Martinuzzo M, Cerrato G, Pombo G, Carreras LO. Factor V Leiden and prothrombin G20210A variant are risk factors for venous thromboembolism in the Argentinean population. Thromb Haemost 2000; 83:509-10. [PMID: 10744162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Forastiero R, Martinuzzo M, Adamczuk Y, Carreras LO. Occurrence of anti-prothrombin and anti-beta2-glycoprotein I antibodies in patients with history of thrombosis. J Lab Clin Med 1999; 134:610-5. [PMID: 10595789 DOI: 10.1016/s0022-2143(99)90101-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
New evidence indicates that antibodies to beta2-glycoprotein I (anti-beta2GPI) or to human prothrombin (anti-II)(or to both of these) are specific markers of the antiphospholipid syndrome (APS). They have been mainly associated with thrombotic complications in patients with APS. However, some studies have reported that elevated levels of anti-II, but not of anfi-beta2GPI, imply a risk of venous thrombosis (VT) or arterial thrombosis (AT) in subjects with no previous thrombosis and no antiphospholipid antibodies (aPL) by ELISA. The present study Included 180 patients with a history of thrombosis, 83 of them without aPL (group I) and the remaining 97 diagnosed as having APS (group II). Anti-beta2GPI was found in only 1 of the 83 patients from group I but was found in approximately 50% of those from group II (P < .0001). In contrast, positive anti-II was detected with a high prevalence in patients from group I (VT, 22.6%; AT, 26.7%) and in those from group II (VT, 37.5%; AT, 14.6%). No statistical differences were found in the prevalence of anti-II between the two groups of patients. On the other hand, such a difference was significant when compared with results in a normal group (1/67, 1.4%, P < .0001). These data Indicate that anti-II occurs frequently in patients with previous thrombosis either with or without lupus anticoagulant activity. Accordingly, testing of anti-II might be clinically useful in the evaluation for thrombophilla.
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Affiliation(s)
- R Forastiero
- Department of Hematology, Favaloro University, Buenos Aires, Argentina
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de Larrañaga G, Forastiero R, Carreras LO, Zala N, Guzman L, Alonso B. Acquired hypoprothrombinemia related to high titres of antiprotein-phospholipid antibodies. Thromb Haemost 1999; 81:317-8. [PMID: 10064016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Forastiero R, Martinuzzo M, Carreras LO, Maclouf J. Anti-beta2 glycoprotein I antibodies and platelet activation in patients with antiphospholipid antibodies: association with increased excretion of platelet-derived thromboxane urinary metabolites. Thromb Haemost 1998; 79:42-5. [PMID: 9459320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Platelet activation may contribute to the increased risk of thrombotic complications in patients with antiphospholipid antibodies (aPL). The increased urinary excretion of 11-dehydro-thromboxane B2 (11-DH-TXB2) reported in patients with lupus anticoagulant (LA) and/or anticardiolipin antibodies (aCL) reflects in vivo platelet activation. However the majority of autoimmune aPL are directed to beta2 glycoprotein I (beta2GPI) or prothrombin (II). We investigated the relationship of these antibodies with 11-DH-TXB2 urinary excretion in 34 patients with aPL. The urinary 11-DH-TXB2 was measured by EIA after extraction on octadecyl columns and purification on silica gel columns, which was validated by thin-layer chromatography/EIA procedure. A significantly increased excretion of 11-DH-TXB2 was found in aPL patients as compared to 18 normal controls (p <0.01). But no differences were seen in the excretion of 11-DH-TXB2 between patients with or without LA, or aCL. The number of patients with anti-II antibodies was too small to draw any conclusion. In contrast, patients with anti-beta2GPI antibodies IgG at moderate/high titre (group A, n = 14) had higher levels of urinary 11-DH-TXB2 than those at low titre or negative (group B, n = 20) (p = 0.01). The group A of patients presented an increase in 11-DH-TXB2 compared to controls (p <0.001), but no statistically significant difference was found between patients from the group B and normal controls. A correlation between levels of urinary 11-DH-TXB2 and titre of antibodies was only found for anti-beta2GPI-IgG (r(s) = 0.51, p <0.005). Our data show that the observed platelet activation in aPL patients is related to the presence of antibodies reacting with beta2GPI.
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Affiliation(s)
- R Forastiero
- University Institute of Biomedical Sciences, Favaloro Foundation, Buenos Aires, Argentina
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Martinuzzo M, Forastiero R, Adamczuk Y, Cerrato G, Carreras LO. Activated protein C resistance in patients with anti-beta 2 glycoprotein I antibodies. Blood Coagul Fibrinolysis 1996; 7:702-4. [PMID: 8958393 DOI: 10.1097/00001721-199610000-00007] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
To evaluate if the presence of anti-beta 2GPI antibodies (a beta 2GPI) is associated with activated protein C resistance (APC-R) phenotype, we performed the APC-R APTT-based assay in 74 plasma samples from patients with antiphospholipid antibodies (aPL). Samples were diluted 1:5 in factor V-deficient plasma. Lupus anticoagulant (LA), anticardiolipin antibodies (aCL) and a beta 2GPI (IgG and IgM) were also performed. A control group of 22 healthy volunteers was used. The prevalence of reduced APC-R ratio in patients with aPL was significantly higher than in normal controls (31.1 vs 4.5%, P < 0.05) and the mean APC-R ratio was lower (mean +/- SD; 2.32 +/- 0.40 vs 2.55 +/- 0.21, P < 0.02). There were no differences in the prevalence of APC-R and the ratio values between LA(+) and LA(-). Among the LA(+), the aCL(+) had a higher prevalence of APC-R than the aCL(-) (P < 0.01) and lower APC-R ratios (P < 0.01). The latter group was no different to normal controls. Anti-beta 2GPI antibodies were associated with a higher prevalence of APC-R (50.0 vs 19.6%, P < 0.001), and lower APC-R ratios (2.15 +/- 0.41 vs 2.42 +/- 0.35, P < 0.005), compared with a beta 2GPI(-). In conclusion, the acquired APC-R in patients with aPL seems to be associated with aCL and a beta 2GPI rather than an in vitro interference by LA.
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Affiliation(s)
- M Martinuzzo
- University Institute of Biomedical Sciences, Buenos Aires, Argentina
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