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Diagnosis of antiphospholipid syndrome

Nature Clinical Practice Rheumatology volume 1, pages 40–46 (2005)Cite this article

Abstract

Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by recurrent vascular thrombosis and pregnancy losses. Laboratory diagnosis of APS relies on the demonstration of a positive anticardiolipin antibody test by an in-house or commercially available enzyme-linked immunosorbent assay, or on the presence of lupus anticoagulant by a coagulation-based test. Persistence of the positive results must be demonstrated, and other causes and underlying factors considered. Although it is universally recognized that the routine screening tests (anticardiolipin antibody or lupus anticoagulant) might miss some cases of APS, careful differential diagnosis and repeat testing are mandatory before the diagnosis of 'seronegative APS' can be made. Correct identification of patients with APS is important because prophylactic anticoagulant therapy can prevent thrombosis from recurring and treatment of affected women during pregnancy can improve fetal and maternal outcome.

Key Points

  • Antiphospholipid syndrome (APS) is the most common acquired thrombophilia

  • Venous and arterial thrombosis in young individuals, and pregnancy morbidity, are the hallmarks of the disease

  • In the clinical setting, testing for both anticardiolipin antibodies and lupus anticoagulant is essential for the diagnosis of APS

  • Differential diagnoses must be considered before labelling a patient as having 'seronegative APS'

  • Correct identification of patients with APS is important, because prophylactic anticoagulant therapy can prevent thrombosis from recurring

  • Treatment of affected women during pregnancy can improve fetal and maternal outcomes

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Author information

Authors and Affiliations

  1. Postdoctoral Research Associate at The Rayne Institute, Guy's, King's and St Thomas' School of Medicine, St Thomas' Hospital, London, UK

    Maria Laura Bertolaccini

  2. Senior Lecturer and a Consultant Physician at The Rayne Institute, Guy's, King's and St Thomas' School of Medicine, St Thomas' Hospital, London, UK

    Munther A Khamashta

  3. Head of the Lupus Research Unit at The Rayne Institute, Guy's, King's and St Thomas' School of Medicine, St Thomas' Hospital, London, UK

    Graham RV Hughes

Authors
  1. Maria Laura Bertolaccini
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  2. Munther A Khamashta
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  3. Graham RV Hughes
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Correspondence to Graham RV Hughes.

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Bertolaccini, M., Khamashta, M. & Hughes, G. Diagnosis of antiphospholipid syndrome. Nat Rev Rheumatol 1, 40–46 (2005). https://doi.org/10.1038/ncprheum0017

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