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The estimated frequency of antiphospholipid antibodies in young adults with cerebrovascular events: a systematic review
  1. Savino Sciascia1,2,
  2. Giovanni Sanna3,
  3. Munther A Khamashta1,3,
  4. Maria Jose Cuadrado3,
  5. Doruk Erkan4,
  6. Laura Andreoli5,
  7. Maria Laura Bertolaccini1
  8. on behalf of APS Action
  1. 1Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, London, UK
  2. 2Centro di Ricerche di Immunologia Clinica ed Immunopatologia e Documentazione su Malattie Rare (CMID), Università di Torino, Torino, Italy
  3. 3Louise Coote Lupus Unit, Guy's and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, London, UK
  4. 4Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, and Weill Medical College of Cornell University, New York
  5. 5Rheumatology and Clinical Immunology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
  1. Correspondence to Dr Maria Laura Bertolaccini, Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, 4th Floor Lambeth Wing, St Thomas’ Hospital, London SE1 7EH, UK; maria.bertolaccini{at}kcl.ac.uk

Abstract

Background Around 10% of all thrombotic cerebrovascular events (CVE) occur in young population and in a large proportion of those the trigger remains undetermined. Antiphospholipid antibodies (aPL) are recognised risk factors for ischaemic stroke and recurrent thrombotic events; however, the frequency of aPL in young people with CVE is still an unresolved issue.

Objectives To estimate the frequency of aPL in young adults with CVE and to determine whether aPL-positive young individuals are at greater risk of CVE when compared with individuals without aPL by systematically reviewing the literature.

Methods Medline reports published between 1970 and 2013 investigating the presence of aPL in young patients (<50 years old) with CVE were included. The median frequency for positive aPL, including lupus anticoagulant, anticardiolipin antibodies (aCL) and antibodies against β2Glycoprotein I (anti-β2GPI), was calculated for stroke and transient ischaemic attacks.

Findings This systematic review is based on available data from 5217 patients and controls from 43 studies analysing the frequency of aPL in young patients with CVE. The overall aPL frequency was estimated as 17.4% (range 5%–56%) for any CVE, 17.2% (range 2%–56%) for stroke and 11.7% (range 2%–45%) for transient ischaemic attack (TIA). The presence of aPL increased the risk for CVE by 5.48-fold (95% CI 4.42 to 6.79). Based on available data, the frequency of aPL in young patients with CVE can be estimated at 17%, rising up to 22% for aCL in patients with stroke. The presence of aPL seems to confer a fivefold higher risk for stroke or TIA when compared with controls. However, variability in test reproducibility and cut-off definition still represent an important methodological limitation for the current diagnostic testing for aPL. These observations should be confirmed by appropriately designed population studies.

  • Antiphospholipid Antibodies
  • Antiphospholipid Syndrome
  • Anticardiolipin Antibodies
  • Autoimmune Diseases

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