Demographic, Clinical, and Serological Characteristics of Antiphospholipid Syndrome Patients From the Anticoagulation Clinic of Hospital Universitario San Vicente Fundación, Medellín, Colombia

Abstract

Introduction: Antiphospholipid syndrome (APS) is an acquired autoimmune thrombophilia, characterized by vascular thrombosis or obstetric compromise, associated with the presence of antiphospholipid antibodies. Large international studies have analyzed the clinical/serological behavior of the disease and in Colombia, there are few cohorts that have been evaluated.Objective: The main objective is to characterize the patients with APS followed in the anticoagulation clinic of a tertiary care hospital and to determine the clinical manifestations and serological findings at diagnosis. Materials and methods: A retrospective descriptive study was carried out to evaluate patients with a presumptive and/or confirmed diagnosis of APS, according to modified Sapporo criteria, which fulfilled the inclusion and exclusion criteria established by the authors. The information was collected from the review of medical records.Results: We included 103 patients, with the female sex being the most prevalent (86.6%). 54.3% of the patients (n = 56) had a diagnosis of primary APS. Venous thrombotic events occurred in 87.3% (n = 90) of the patients, 34.9% (n = 36) had arterial thrombosis (n = 36), and 3.9% (n = 4) had catastrophic APS (n = 4). 15 cases of Obstetric APS were documented. Lupus coagulation inhibitor (LA) positivity was the most prevalent marker in 84% (n = 68) of cases.Conclusions: The clinical behavior in this cohort of patients is like that found in large international and national studies. Most patients have a probable diagnosis of APS, so they could overestimate the real prevalence and condition of long-term anticoagulant treatment.

Epidemiology of antiphospholipid syndrome: macro- and microvascular manifestations

“…Venous thrombosis, either as initial or recurrent events, is more prevalent than arterial thrombosis, with estimates ranging from ∼40% to 50% [ 9 , 30–35 ] to >60% of patients [ 8 , 36 , 37 ]. The demographic characteristics (age, sex and race/ethnicity), disease duration, co-existence of risk factors for venous thrombosis (trauma, surgery, immobilization, oestrogen use or obesity) and the access to a health care system, modulate how APS manifests worldwide.…”

“…Deep venous thrombosis (DVT) is the most frequent venous thrombosis manifestation in APS, affecting 30–40% of patients [ 8 , 9 , 30 , 31 , 33 , 34 , 36 ] ( Table 2 ). The deep veins of the lower limbs are the most common sites of thrombosis, affecting more than one-third of patients in most regional and international cohorts [ 8 , 9 , 30 , 34 , 37 ]. The upper limbs can also be affected, although with a much lower prevalence (∼1% to 3%).…”

“…Pulmonary embolism is the most frequent pulmonary manifestation in APS, affecting 11% to 20% of individuals [ 8 , 9 , 31 , 36 , 37 ] and can be the presenting manifestation in about 9% to 12% of patients [ 8 , 9 , 31–34 ]. It may occur as an isolated entity, but more often follows a lower limb DVT [ 40 ].…”

“…In the Euro-Phospholipid Project including 1000 APS subjects [ 8 ], only seven (0.7%) patients presented with a CVT. Further studies, including the APS ACTION registry, report a prevalence of around 2% [ 9 ] to 5% [ 36 , 37 ] in APS. On the other hand, APS contributes to a significant proportion (∼6% to 17%) of CVT cases in large studies in the general population [ 53 , 54 ].…”

“…The diagnosis of microvascular manifestations may be challenging because, in addition to their rarity, current classification criteria require, along with appropriate imaging, a confirmation with histopathology studies [ 1 ]. A high heterogeneity in the methodology of clinical studies reporting microthrombotic events still exists, further challenging the accuracy of available epidemiological data; while some studies follow the APS classification criteria for microvascular events [ 8 , 9 , 30 , 35 ], this does not hold true for others [ 36 , 37 , 134 ].…”