International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome: Report of an International workshop

Thrombotic recurrences and bleeding events in APS vascular patients: A review from the literature and a comparison with the APS Piedmont Cohort

“…The Authors report observing no differences between the results of the two treatments, nor that aPL status predicted vascular occlusive events. There was a great deal of criticisms concerning the study design, and some comments are summarized in JAMA, June 2004 [27] by Cabral et al, Ruiz Irastorza et al, Wahl et al In summary, the mean age of patients was high, no confirmation tests were performed, only 0.2% patients had elevated aCL levels, and many patients were aPL positive (41%), leading to doubts concerning the specificity of the test, and the INR therapeutic target range was unusual and lower than the standard, most often recommended one [2] and [3]. More recently, the risk of ischaemic stroke and of myocardial infarction, has been shown to be very high in young women with lupus anticoagulant, in the RATIO study [28].…”

“…Since Feinstein and Rapaport [1] used the term "lupus anticoagulant" for the first time in 1972, classification criteria for clinical and laboratory diagnosis have been proposed twice: i.e. Wilson et al [2], in 1999 (the so-called "Sapporo" criteria), and the current ones, in 2006, by Miyakis et al [3], (the "Sydney" criteria). These classification criteria have been formulated to allow a well-defined and shared picture of the syndrome.…”

Management of the obstetric antiphospholipid syndrome

“…In women with Ն3 spontaneous abortions, a normal embryonic ultrasound beyond 6-8 weeks of gestation provides a favorable prognosis with a Ն80% chance for a live birth (13). The preliminary classification criteria for definite APS published in 1999 (14) (Table 1) include this refined classification of pregnancy loss and recognize that a preterm live birth accompanied by severe preeclampsia or severe placental insufficiency is comparable with a loss late in pregnancy.…”

“…The serologic criteria for APS are the persistent presence of lupus anticoagulant (LAC) or medium-tohigh levels of IgG or IgM anticardiolipin antibodies (aCL) (7,14). LAC refers to antibodies that prolong in vitro clotting times of plasma by interference with assemblage of components of the coagulation cascade on a phospholipid template (15).…”

“…In contrast to women in the second and third categories, patients in the first category (low risk) did not receive pharmacologic treatment. We will critically review these studies, emphasizing whether or not patients met the classification criteria for APS (14).…”