Background Stroke and transient ischemic attack (TIA) are the most common neurologic manifestation of antiphospholipid syndrome (APS). The international consensus criteria for APS classification require persistent antiphospholipid antibodies (aPL) positivity (at least 12 weeks apart) and medium or high titer for anticardiolipin antibody (aCL) associated with clinical manifestations . To confirm the diagnosis of a patient who comes with stroke/TIA and positive aPL as definite APS, we serially check the positivity of aPL in addition to titer of aCL. However, significance of persistence and moderate or high titer of aPL on the clinical relevance is not identified.
Objectives To evaluate the effect of persistent and medium or high titer of aPL positivity on recurrence in patients with ischemic stroke/TIA.
Methods We reviewed medical records of 99 patients with ischemic stroke/TIA who had at least one or more positive aPL (ie, positivity for anticardiolipin antibodies [aCL], β2-glycoprotein I antibodies [β2-GPI], lupus anticoagulant antibodies [LA]). We divided these patients into two groups according to the most recent revised classification (Sydney consensus conference), and designated as “definite APS” who fulfilled the laboratory criteria, and “aPL carriers” who had transient or low titer aPL. We compared the subsequent ischemic stroke/TIA events between the two groups.
Results Of the 99 patients, 46 (46%) were classified as definite APS and 53 (54%) as aPL carriers. There was no increased risk of subsequent ischemic/TIA events in definite APS group compared with aPL carriers group. The overall event was 14 (30.4%) in APS group and 16 (30.2%) in aPL carriers group during 60.4 months and 43.8 months follow up period respectively. 38 patients were having anticoagulation for treatment and 60 patients were on anti-platelet treatment without anticoagulation, but there was no difference on recurrence events regarding the treatment. Among definite APS group, there was no difference in recurrence events according anticoagulation vs anti-platelet agent.
Conclusions The persistence and medium or high titer of aPL enables to diagnose APS in ischemic stroke/TIA patients, but does not predict increased risk for subsequent ischemic stroke/TIA.
Rand JH. The antiphospholipid syndrome. Hematology Am Soc Hematol Educ Program 2007:136–142
Disclosure of Interest None declared