Antiphospholipid Antibodies and Recurrent Thrombotic Events: Persistence and Portfolio

Area of Science:

• Immunology
• Neurology
• Cardiology

Background:

• Limited prospective data exist on persistent antiphospholipid antibodies (aPL) and recurrent thrombo-occlusive events (TOEs).
• This study investigated the prognostic value of newer aPL assays, aPL portfolios, and persistent aPL positivity post-stroke.

Purpose of the Study:

• To evaluate the predictive significance of specific antiphospholipid antibodies (aPL) and their persistence for recurrent thrombo-occlusive events (TOEs) in stroke patients.
• To assess the utility of newer aPL assays and aPL portfolios in risk stratification.

Main Methods:

• 1,770 subjects from the APASS-WARSS study were tested for antibodies to phosphatidylserine (aPS) and anti-β2-glycoprotein-I (anti-β2GPI).
• Follow-up aPL status was assessed in a subset.
• Cox proportional hazard analyses examined the association between aPL status and time to TOE/death within 2 years.

Main Results:

• Persistent anti-β2GPI was independently associated with a shorter time to TOE/death (HR 2.86).
• Combined persistent anti-β2GPI and another aPL also reduced time to TOE/death (HR 3.79).
• Neither persistent anticardiolipin antibodies, aPS alone, nor single positive aPLs predicted TOE/death risk.

Conclusions:

• Persistent anti-β2GPI, alone or with another aPL, is an independent predictor of recurrent TOE/death.
• Baseline aPL results, aPL portfolios, and newer aPL assays are not predictive of increased TOE rates in ischemic stroke patients.