title: Do patients followed in anticoagulation clinics for antiphospholipid syndrome meet criteria for the disorder?
abstract: Although specific criteria for diagnosing the antiphospholipid syndrome (APS) exist (the Sapporo Criteria), most physicians are not aware these include repeat testing and documentation of either a lupus anticoagulant or medium to high levels of anti-cardiolipin antibody. Incorrect diagnosis of APS may result in unnecessary long-term anticoagulation. The purpose of this study was to determine the clinical and serological characteristics of patients being treated for APS and concordance with published criteria. This cross-sectional study identified APS patients who were being treated with warfarin at one of three university-based anticoagulation clinics. Levels of anticardiolipin antibody were classified as low-positive if abnormal but < 40 GPL/MPL units and medium/high-positive if > or = 40 units. Strength of meeting Sapporo criteria was graded as definite, possible, and not meeting criteria. Of 103 cases, 97 had clinical and laboratory data available. Only 10 cases (10%, 95% Confidence Interval 5 - 19) met criteria for definite APS, 16 (16%, 10 - 26) had a possible diagnosis, and 71 (73%, 63 - 81) did not meet criteria. Of 70 cases that had abnormal anticardiolipin antibody results, only 32 (46%, 34 - 58) had medium/high-positive levels. Repeat laboratory testing was performed in only 49 cases (51%, 40 - 61). We conclude that few patients treated forAPS met Sapporo criteria. Abnormal levels of anticardiolipin antibody were frequently in the low-positive range, and repeat testing was often absent. A quality improvement program that includes review of cases referred for chronic anticoagulation care is recommended to ensure appropriate testing and treatment of patients with suspected APS.
authors.affiliation: Division of General Medicine, Mount Sinai School of Medicine, 1470 Madison Ave, Box 1087, New York, NY 10029, USA. andrew.dunn@mountsinai.org
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Dunn
authors.forename: Peter
authors.initials: P
authors.lastname: Kaboli
authors.forename: Thorvardur
authors.initials: T
authors.lastname: Halfdanarson
authors.forename: Happy
authors.initials: H
authors.lastname: Chan
authors.forename: Rod
authors.initials: R
authors.lastname: Hubert
authors.forename: Seth
authors.initials: S
authors.lastname: Rosen
authors.forename: Richard H
authors.initials: RH
authors.lastname: White
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017153:Antibodies, Anticardiolipin / Q000097:blood; D000925:Anticoagulants / Q000627:therapeutic use; D016736:Antiphospholipid Syndrome / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D003430:Cross-Sectional Studies; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000592:standards; D008499:Medical Records; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012698:Serologic Tests / Q000592:standards; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D017153:Antibodies, Anticardiolipin; D000925:Anticoagulants; D014859:Warfarin