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Blood, 15 August 2007, Vol. 110, No. 4, pp. 1178-1183. Prepublished online as a Blood First Edition Paper on April 17, 2007; DOI 10.1182/blood-2007-01-066043.
HEMOSTASIS, THROMBOSIS, AND VASCULAR BIOLOGY Clinical significance of different antiphospholipid antibodies in the WAPS (warfarin in the antiphospholipid syndrome) study1 Divisione di Ematologia, Ospedali Riuniti, Bergamo, Italy; 2 Laboratory of Epidemiology, Istituto Mario Negri Sud, S. Maria Imbaro, Chieti, Italy; 3 Ulleval Hospital, Oslo, Norway; 4 Diagnostica Stago, Asnieres, France To assess the clinical significance of lupus anticoagulants (LAs) and antiphospholipid antibodies (aPLs) toward thrombosis and abortions, we measured them in 112 patients whose samples were available at enrollment in the warfarin in the antiphospholipid syndrome (WAPS) study. Enzyme-linked immunosorbent assay (ELISA) and coagulation test values in the highest and lowest tertiles were compared. When considered separately, IgG antibodies to ß2-glycoprotein I (aß2GPI) and prothrombin (aPT) were associated with anamnestic arterial and venous thrombosis, respectively, and those to annexin AV (aAnAV) with abortions. IgM antibodies to protein S and the lupus ratio of the dilute prothrombin time were associated with prospective thrombosis. No other association for IgM antibodies was seen. LA-positive patients who carried aß2GPI antibodies were at risk of anamnestic arterial and total thrombosis and aPT antibodies to that of anamnestic venous and total thrombosis. LA-positive patients who carried IgG aß2GPI and aAnAV antibodies were at risk for both anamnestic abortion and prospective thrombosis. Overall, these data support the inclusion of aß2GPI antibodies in and suggest the removal of anticardiolipin antibodies from the laboratory criteria of the antiphospholipid syndrome. They also suggest that the measurement of aPT and aAnAV antibodies is useful in some selected situations and that there is little role for IgM antibody detection.
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