Department of Laboratory Haematology, Austin Hospital, Studley Road, Melbourne, VIC, 3084, Australia.
J Thromb Thrombolysis. 2020 Apr;49(3):446-450. doi: 10.1007/s11239-020-02053-3.
The anti-phospholipid syndrome (APS) is defined by the laboratory detection of at least one of three anti-phospholipid autoantibodies (lupus anticoagulant, or anti-cardiolipin or anti-β-glycoprotein I antibodies) in the clinical setting of thrombosis or pregnancy morbidity in a patient. Recognising APS and administering appropriate secondary thromboprophylaxis is important to reduce risk of recurrent thrombosis and/or pregnancy morbidity. In some instances, patients having clinical manifestations highly suggestive of APS are persistently negative for these antibodies but instead have other autoantibodies. Autoantibodies directed against prothrombin (PT) have been associated with increased thrombotic risk and comprise anti-prothrombin (aPT) and anti-phosphatidylserine/prothrombin (aPS/PT) antibodies. Detection of aPT and aPS/PT may help stratify patients for more effective treatment, however, their prevalence among patients with unprovoked venous thromboembolism (VTE) is unknown and determination of their frequencies is the objective of this study. Sera from 148 patients with unprovoked VTE were analysed. Autoantibodies directed against PT collectively, aPT and aPS/PT were present in 24.3%, 14.9% and 13.5%, respectively. Prevalence of these autoantibodies in unprovoked VTE is much lower compared to cohorts comprising mainly patients with systemic autoimmune disorders. Detection of these autoantibodies in unprovoked VTE has potential therapeutic implications for patients including the duration of anticoagulation and administration, or otherwise, of direct oral anticoagulants. Data from this study will assist in the design of future clinical studies to estimate risk of recurrent VTE and to determine optimal management.
抗磷脂综合征 (APS) 是指在临床环境中，患者存在血栓形成或妊娠并发症，且实验室检测到至少一种三种抗磷脂自身抗体（狼疮抗凝物、抗心磷脂或抗β-糖蛋白 I 抗体）。识别 APS 并进行适当的二级血栓预防对于降低复发性血栓形成和/或妊娠并发症的风险非常重要。在某些情况下，具有高度提示 APS 临床表现的患者持续对这些抗体呈阴性，但具有其他自身抗体。针对凝血酶原 (PT) 的自身抗体与血栓形成风险增加有关，包括抗凝血酶原 (aPT) 和抗磷脂酰丝氨酸/凝血酶原 (aPS/PT) 抗体。检测 aPT 和 aPS/PT 可能有助于对患者进行更有效的治疗分层，但是它们在未诱发静脉血栓栓塞症 (VTE) 患者中的患病率尚不清楚，确定它们的频率是本研究的目的。分析了 148 例未诱发 VTE 患者的血清。针对 PT 的自身抗体总体上，aPT 和 aPS/PT 的存在率分别为 24.3%、14.9%和 13.5%。与主要由系统性自身免疫性疾病患者组成的队列相比，这些自身抗体在未诱发 VTE 中的患病率要低得多。在未诱发 VTE 中检测到这些自身抗体对患者具有潜在的治疗意义，包括抗凝时间以及直接口服抗凝剂的使用或其他治疗方法。本研究的数据将有助于设计未来的临床研究，以估计复发性 VTE 的风险，并确定最佳管理方案。
