Abstract Number: PB1927
Meeting: ISTH 2020 Congress
Theme: Thrombotic Microangiopathies » Antiphospholipid Syndrome
Background: Triple positivity (positivity for lupus anticoagulant (LAC), anti-cardiolipin (aCL) and anti-B2 glycoprotein) is associated with high risk for thrombosis and recurrence.
Aims: We evaluated the 10 year thrombotic outcomes and mortality of 37 patients with triple positive antiphospholipid antibodies detected from 2010 to 2019.
Methods: We included 37 patients from Tan Tock Seng Hospital, Singapore. Presence of LAC was confirmed with STA-Staclot and DRVV Lupus anticoagulant assay, while aCL were determined using INOVA QUANTA Lite IgG III and IgM III, anti-B2 glycoprotein (aBGP) by Euroimmun Test System (ELIZA).
Results: 37 patients had triple positivity, (14 male 23 female, age 17-87 years). All 37 had presence of LAC and anti B2 glycoprotein, 30 were positive for aCL IgG and 24 positive for aCL IgM. 14 had triple positivity with no initial thrombosis, of which 3 later developed thrombosis (after 7 months, 4 and 6 years). 14 had primary anti-phospholipid syndrome (APS) and 9 had secondary APS (6 SLE, 2 SLE/Sjogrens overlap, 1 HIV). 15 had a single thrombotic event, 4 had 2 thrombotic events, 6 had multiple thrombotic events. 10 had venous thrombosis, 8 small vessel thrombosis, 5 had arterial thromboembolism, 2 combined venous and arterial thromboembolisms. Sites of thrombosis included 16 brain ischaemic and small vessel strokes, 12 lower limb DVT, 3 adrenal haemorrhages, 3 recurrent miscarriages, 2 myocardial infarctions, 1 kidney infarcts and 1 retinal ischaemic retinopathy. 21 (56%) had concurrent thrombocytopenia upon APS antibody testing. 24 out of 26 patients with APS had long term warfarin, 2 developed major bleeding (haematuria). 3 had thrombosis related death (1 pulmonary embolism, 1 brain stroke and 1 catastrophic APS).
Conclusions: Triple positivity is associated with a high risk for thrombosis with a 10-year cumulative incidence of 70.3% (26 out of 37 patients) and a high 8.1% thrombotic associated mortality.
To cite this abstract in AMA style:
Fan BE, Sum CLL. Triple Positive Antiphospholipid Antibodies: A 10-year Retrospective Review of 37 Patients with Triple Positive Antiphospholipid Antibodies and their Thrombotic Outcomes and Mortality in a Single Centre in Singapore [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/triple-positive-antiphospholipid-antibodies-a-10-year-retrospective-review-of-37-patients-with-triple-positive-antiphospholipid-antibodies-and-their-thrombotic-outcomes-and-mortality-in-a-single-cent/. Accessed March 21, 2024.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/triple-positive-antiphospholipid-antibodies-a-10-year-retrospective-review-of-37-patients-with-triple-positive-antiphospholipid-antibodies-and-their-thrombotic-outcomes-and-mortality-in-a-single-cent/