Antiphospholipid antibodies in pulmonary embolism treated with direct oral anticoagulants: Prevalence data from unselected consecutive patients

Tummas Justinussen; Jorgen Brodersen Gram; Mustafa Vakur Bor

doi:10.1016/j.rpth.2023.100050

Antiphospholipid antibodies in pulmonary embolism treated with direct oral anticoagulants: Prevalence data from unselected consecutive patients

Res Pract Thromb Haemost. 2023 Jan 18;7(1):100050. doi: 10.1016/j.rpth.2023.100050. eCollection 2023 Jan.

Authors

Tummas Justinussen¹, Jorgen Brodersen Gram^{1

2}, Mustafa Vakur Bor^{1

2}

Affiliations

¹ Department of Clinical Biochemistry, Thrombosis and Anticoagulation Clinic, University Hospital of Southern Denmark, Esbjerg, Denmark.
² Department of Regional Health Research, Unit for Thrombosis Research, University of Southern Denmark, Esbjerg, Denmark.

Abstract

Background: Direct oral anticoagulants (DOACs) are the first-choice treatment option for the prevention of the recurrence of venous thrombosis in patients with pulmonary embolism (PE); however, their effect in patients with antiphospholipid syndrome (APS) is challenged. Therefore, the prevalence of antiphospholipid autoantibodies in patients with PE is noteworthy.

Objectives: To determine the prevalence of unselected patients presenting with PE who meet the criteria for APS based on elevated levels of anticardiolipin (aCL) and anti-β2-glycoprotein I (aβ2GPI) antibodies.

Methods: Consecutive patients with PE, in whom DOACs were primarily initiated, were tested for aCL and aβ2GPI. If the levels were elevated, the tests were repeated after 12 weeks for APS diagnosis. Laboratory results and patient characteristics were retrospectively collected from a laboratory information system and electronic patient journal entries over a 2-year period.

Results: The prevalence of APS based on consistently elevated levels of aCL or aβ2GPI was 3.7% (10 of 267 patients). Three patients were double positive. In 11 out of 21 patients (52%) with initially elevated values, the levels of the antibodies normalized after 12 weeks. The patient characteristics were largely similar in those with APS and those without APS; however, patients with APS tended to be older and more likely to receive antithrombotic treatment at the time of PE.

Conclusion: We found a relatively low prevalence of APS based on aCL or aβ2GPI. The high rate of normalized levels of the antibodies after 12 weeks reaffirms the need for repeated tests for APS diagnosis. Older patients more frequently met the criteria for APS. Determining the effectiveness of DOACs in non-triple-positive patients with APS following venous thromboembolism is important to further determine the feasibility of unselected tests in patients with PE.

Keywords: anti-β2 glycoprotein I autoantibody; anticardiolipin antibodies; anticoagulants; antiphospholipid syndrome; pulmonary embolism; thrombosis.