The Catastrophic Antiphospholipid Syndrome in Serbia: Diagnostic and Management Problems

Stojanovich, Ljudmila

doi:10.1007/s12016-008-8102-1

Cited by 8 publications

(7 citation statements)

References 35 publications

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“…The main reasons for exclusion included: no correlation of serologic results with thrombosis; measurement of only IgG or only IgM antibodies; no discrimination between IgG and IgM antibodies; presentation of combined antibody results; only LA/non‐criteria antibodies being measured; and the inclusion of overlapping patient populations. Thus, 177 studies were included in this systematic review . Those studies were grouped according to their analysis method: those containing ORs for thrombosis or allowing their calculation, and those for which, owing to a lack of information, only the percentage of positive patients in the thrombotic population can be shown.…”

Section: Resultsmentioning

confidence: 99%

IgG/IgM antiphospholipid antibodies present in the classification criteria for the antiphospholipid syndrome: a critical review of their association with thrombosis

Kelchtermans

Pelkmans

Laat

et al. 2016

Journal of Thrombosis and Haemostasis

103

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The clinical value of IgM antibodies in thrombotic antiphospholipid syndrome (APS) is debated. By review of literature, we reconsidered the clinical value of IgM antibodies in thrombotic APS. More significant correlations with thrombosis were found for the IgG compared to IgM isotype. Unavailability of paired IgG/IgM results hampers evaluating the added value of IgM positivity. https://www.youtube.com/watch?v=XTMLAqOkJ7w Summary BackgroundDespite the update of the classification criteria for the antiphospholipid syndrome (APS), difficulties persist in the identification of patients at risk for thrombosis. Current guidelines include assays detecting IgG/IgM anti‐β2‐glycoprotein I and anti‐cardiolipin antibodies, although the relevance of IgM antibodies has been debated. ObjectivesThrough a review of the literature from 2001 to 2014, we aimed to formally establish the thrombotic risk stratification potential of IgM as compared with IgG anti‐phospholipid antibodies (aPLs). Patients/methodsOne thousand two hundred and twenty‐eight articles were selected by a computer‐assisted search of the literature. Of the 177 studies that met our inclusion criteria, the clinical value of IgG/IgM aPLs was established through analysis of odds ratios for thrombosis or percentage of positives in the thrombotic population. Results/conclusionsWe clearly found more significant correlations with thrombosis for the IgG than for the IgM isotype. Nonetheless, in a minority of studies, significant associations with thrombosis were found for IgM but not IgG antibodies. The unavailability of paired results of IgG and IgM for each separate patient hampers evaluation of the added value of isolated IgM positivity. To fully take advantage of results obtained by future studies, we strongly encourage scientists to provide all studied information per patient. We planned a large multicenter study to investigate clinical associations of isolated/combined positivity for criteria/non‐criteria aPLs. Importantly, because of the presence of non‐pathogenic aPLs, quantitative assays are characterized by a high false‐positivity rate. Optimization of functional assays, such as thrombin generation measuring the whole scheme of coagulation, may help to reduce APS‐related morbidity and mortality.

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Section: Resultsmentioning

confidence: 99%

IgG/IgM antiphospholipid antibodies present in the classification criteria for the antiphospholipid syndrome: a critical review of their association with thrombosis

Kelchtermans

Pelkmans

Laat

et al. 2016

Journal of Thrombosis and Haemostasis

103

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“…Among these patients, 14 presented with catastrophic APS (CAPS) and were included into the international registry of CAPS patients (CAPS Registry), which was created in 2000 by the European Forum on Antiphospholipid Antibodies. 17,18…”

Section: Methodsmentioning

confidence: 99%

The cutaneous manifestations are significantly related to cerebrovascular in a Serbian cohort of patients with Hughes syndrome

Stojanovich

Djoković

Stanisavljević

et al. 2018

Lupus

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Objectives To investigate a possible relationship between cerebrovascular, such as stroke and transient ischaemic attack, and various cutaneous manifestations (livedo reticularis, skin ulcerations, pseudovasculitis lesions, superficial cutaneous necrosis and digital gangrene) in antiphospholipid syndrome (APS). This report is based on a Serbian cohort of APS patients. Methods A total of 508 antiphospholipid syndrome APS patients were assessed: 360 with primary (PAPS) and 148 with APS associated with SLE (SAPS). Antiphospholipid antibodies analysis included detection of anti-cardiolipin (IgG/IgM), anti-ßglycoprotein I (IgG/IgM) and positive lupus anticoagulant test. Results The prevalence of cutaneous manifestations in our cohort was significantly higher in the SAPS group (76.4% vs. 27.2%, p = 0.0001). In both groups, the most common manifestation was livedo reticularis. The majority of cutaneous manifestations were significantly associated with cerebrovascular events in SAPS and PAPS. Cutaneous manifestations were independent predictors of transient ischaemic attack and stroke in PAPS patients (odds ratio 2.850, 95% confidence interval 1.562-5.202, p = 0.001, odds ratio 1.832, 95% confidence interval 1.024-3.277, p = 0.041, respectively). Conclusion In this cross-section analysis of a large cohort of Serbian APS patients, there was a strong relationship between cutaneous and cerebrovascular manifestations, suggesting a more cautious approach regarding neurological symptoms, especially in PAPS patients with cutaneous manifestations present.

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“…Supporting evidence. Six studies were retrieved [4,[14][15][16]19,20]. Most patients (319/343) were from the CAPS Registry.…”

Section: Recommendation 6: For First-line Treatment Of Patients With mentioning

confidence: 99%

McMaster RARE‐Bestpractices clinical practice guideline on diagnosis and management of the catastrophic antiphospholipid syndrome

Legault

Schünemann

Hillis

et al. 2018

Journal of Thrombosis and Haemostasis

118

101

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Background The McMaster RARE-Bestpractices project group selected the catastrophic antiphospholipid syndrome (CAPS) for a pilot exercise in guideline development for a rare disease. Objectives The objectives of this exercise were to provide a proof of principle that guidelines can be developed for rare diseases and assist in clinical decision making for CAPS. Patients/Methods The GIN-McMaster Guideline Development checklist and GRADE methodology were followed throughout the guideline process. The CAPS guideline was coordinated by a steering committee, and the guideline panel was formed with representation from all relevant stakeholder groups. Systematic reviews were performed for the key questions. To supplement the published evidence, we piloted novel methods, including use of an expert-based evidence elicitation process and ad hoc analysis of registry data. Results This paper describes the CAPS guideline recommendations, including evidence appraisal and discussion of special circumstances and implementation barriers identified by the panel. Many of these recommendations are conditional, because of subgroup considerations in this heterogeneous disease, as well as variability in patient values and preferences. Conclusions The CAPS clinical practice guideline initiative met the objective of the successful development of a clinical practice guideline in a rare disease using GRADE methodology. We expect that clinicians caring for patients with suspected CAPS will find the guideline useful in assisting with diagnosis and management of this rare disease.

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The Catastrophic Antiphospholipid Syndrome in Serbia: Diagnostic and Management Problems

Cited by 8 publications

References 35 publications

IgG/IgM antiphospholipid antibodies present in the classification criteria for the antiphospholipid syndrome: a critical review of their association with thrombosis

IgG/IgM antiphospholipid antibodies present in the classification criteria for the antiphospholipid syndrome: a critical review of their association with thrombosis

The cutaneous manifestations are significantly related to cerebrovascular in a Serbian cohort of patients with Hughes syndrome

McMaster RARE‐Bestpractices clinical practice guideline on diagnosis and management of the catastrophic antiphospholipid syndrome

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