Clinical significance of different antiphospholipid antibodies in the WAPS (warfarin in the antiphospholipid syndrome) study.

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 beta2-glycoprotein I (abeta2GPI) 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 abeta2GPI 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 abeta2GPI and aAnAV antibodies were at risk for both anamnestic abortion and prospective thrombosis. Overall, these data support the inclusion of abeta2GPI 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.

Antiphospholipid antibodies in lymphoma: prevalence and clinical significance.

To evaluate whether the presence of antiphospholipid antibodies in lymphoma patients influences their response to treatment, and their rate of thromboembolic complications, we followed up 100 consecutive patients with different lymphomas, who underwent measurement of lupus anticoagulants and anticardiolipin antibodies at diagnosis. In all, 27 patients had lupus anticoagulants and/or anticardiolipin antibodies. This prevalence was significantly higher than in a group of 100 age- and sex-matched normal control subjects (8%; P=0.0008, odds ratio 4.25, 95% confidence interval, 1.82-9.92). At diagnosis, antiphospholipid-positive and -negative patients were similar with respect to age, sex, type and staging of lymphomas. During follow-up, the rate of thrombosis was significantly higher in patients with (5.1% patients/year) than without (0.75% patients/year) antiphospholipid antibodies. The two groups were similar with respect to relapse and death rate. In conclusion, antiphospholipid antibodies are associated with lymphomas. Their determination is useful to identify patients at high risk to develop thrombotic complications, but not to predict treatment outcome or disease prognosis.