title: Thrombotic risk assessment in antiphospholipid syndrome: the role of new antibody specificities and thrombin generation assay.
abstract: Antiphospholipid syndrome (APS) is an autoimmune condition characterized by the presence of antiphospholipid antibodies (aPL) in subjects presenting with thrombosis and/or pregnancy loss. The currently used classification criteria were updated in the international consensus held in Sidney in 2005. Vascular events seem to result of local procoagulative alterations upon triggers influence (the so called "second-hit theory"), while placental thrombosis and complement activation seem to lead to pregnancy morbidity. The laboratory tests suggested by the current classification criteria include lupus anticoagulant, a functional coagulation assay, and anticardiolipin and anti-β2-glycoprotein-I antibodies, generally detected by solid phase enzyme-linked immunosorbent assay. The real challenge for treating physicians is understanding what is the actual weight of aPL in provoking clinical manifestations in each case. As thrombosis has a multi-factorial cause, each patient needs a risk-stratified approach. In this review we discuss the role of thrombotic risk assessment in primary and secondary prevention of venous and arterial thromboembolic disease in patients with APS, focusing on new antibody specificities, available risk scoring models and new coagulation assays.
authors.affiliation: Department of Clinical and Biological Sciences, Center of Research of Immunopathology and Rare Diseases- Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Hospital, University of Turin, piazza del donatore di Sangue 3, 10054 Turin, Italy.
authors.forename: Savino
authors.initials: S
authors.lastname: Sciascia
authors.affiliation: Department of Clinical and Biological Sciences, Center of Research of Immunopathology and Rare Diseases- Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Hospital, University of Turin, piazza del donatore di Sangue 3, 10054 Turin, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Baldovino
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust, London, UK.|Department of Rheumatology, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Karen
authors.initials: K
authors.lastname: Schreiber
authors.affiliation: Department of Clinical and Biological Sciences, Center of Research of Immunopathology and Rare Diseases- Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Hospital, University of Turin, piazza del donatore di Sangue 3, 10054 Turin, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Solfietti
authors.affiliation: Department of Clinical and Biological Sciences, Center of Research of Immunopathology and Rare Diseases- Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Hospital, University of Turin, piazza del donatore di Sangue 3, 10054 Turin, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Radin
authors.affiliation: Louise Coote Lupus Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Cuadrado
authors.affiliation: Department of Clinical and Biological Sciences, Center of Research of Immunopathology and Rare Diseases- Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Hospital, University of Turin, piazza del donatore di Sangue 3, 10054 Turin, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Menegatti
authors.affiliation: Barbara Volcker Center for Women and Rheumatic Diseases, New York, USA.|Hospital for Special Surgery, New York, USA.
authors.forename: Doruk
authors.initials: D
authors.lastname: Erkan
authors.affiliation: Department of Clinical and Biological Sciences, Center of Research of Immunopathology and Rare Diseases- Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Hospital, University of Turin, piazza del donatore di Sangue 3, 10054 Turin, Italy.|Department of Clinical and Biological Sciences, SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, University of Turin, Turin, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Roccatello
keywords: APS action; Anti-prothrombin; Anti-β2-glycoprotein-I antibodies; Antiphospholipid antibodies; Antiphospholipid antibody; Antiphospholipid syndrome; Clinical trials; Lupus anticoagulant; Miscarriages; Pregnancy loss; Risk assessment; Thrombin generation assay; Thrombosis