Background: The rate of antiphospholipid antibody (aPL) negativization in antiphospholipid syndrome (APS) patients is uncertain, but it is estimated to be as high as 8%. Currently, a consensus definition of aPL negativization is lacking, as well as international recommendations on how to approach treatment in patients with a persistent aPL-negative seroconversion. Aim: The aim of the Delphi survey was to evaluate the clinical approach and level of consensus among experts from the APS Study Group of the Italian Society for Rheumatology (SIR-APS) in different clinical scenarios. Methods: Experts of SIR-APS were contacted using a survey methodology. Results: A structured survey was circulated among 30 experts. Up to 90% of the interviewed experts agreed on defining aPL negativization as the presence of two negative determinations, 1 year apart (90%). Almost full consensus exists among experts in some clinical settings, including: (1) the role of aPL negativization in the management of a thrombotic event determined by concomitant presence of cardiovascular risk factors, both modifiable and not modifiable (90%); (2) approach to young patients with triple aPL positivity who experienced pulmonary arterial thrombotic events and tested negative for aPL detection after 5 years of vitamin K antagonist (VKA) treatment (90%); (3) the use of "extra criteria" aPL antibody testing before pondering VKA suspension (93%). Conclusion: A substantial agreement exists among experts on how to define aPL negativization. VKA suspension should be embraced with extreme caution, particularly in case of previous thrombotic events and/or triple aPL positivity. Nevertheless, VKA cessation might be considered when risk factors are carefully monitored/treated and the presence of "extra criteria" aPL is ruled out.

Clinical Delphi on aPL Negativization: Report from the APS Study Group of the Italian Society for Rheumatology (SIR-APS)

Savino Sciascia
Co-first
;
Silvia Grazietta Foddai
Co-first
;
Alice Barinotti;Irene Cecchi;Massimo Radin;Elena Rubini;Dario Roccatello;
2022-01-01

Abstract

Background: The rate of antiphospholipid antibody (aPL) negativization in antiphospholipid syndrome (APS) patients is uncertain, but it is estimated to be as high as 8%. Currently, a consensus definition of aPL negativization is lacking, as well as international recommendations on how to approach treatment in patients with a persistent aPL-negative seroconversion. Aim: The aim of the Delphi survey was to evaluate the clinical approach and level of consensus among experts from the APS Study Group of the Italian Society for Rheumatology (SIR-APS) in different clinical scenarios. Methods: Experts of SIR-APS were contacted using a survey methodology. Results: A structured survey was circulated among 30 experts. Up to 90% of the interviewed experts agreed on defining aPL negativization as the presence of two negative determinations, 1 year apart (90%). Almost full consensus exists among experts in some clinical settings, including: (1) the role of aPL negativization in the management of a thrombotic event determined by concomitant presence of cardiovascular risk factors, both modifiable and not modifiable (90%); (2) approach to young patients with triple aPL positivity who experienced pulmonary arterial thrombotic events and tested negative for aPL detection after 5 years of vitamin K antagonist (VKA) treatment (90%); (3) the use of "extra criteria" aPL antibody testing before pondering VKA suspension (93%). Conclusion: A substantial agreement exists among experts on how to define aPL negativization. VKA suspension should be embraced with extreme caution, particularly in case of previous thrombotic events and/or triple aPL positivity. Nevertheless, VKA cessation might be considered when risk factors are carefully monitored/treated and the presence of "extra criteria" aPL is ruled out.
2022
1612
1620
https://pubmed.ncbi.nlm.nih.gov/35292950/
Antiphospholipid syndrome, risk factor, treatment modification, anticoagulation
Savino Sciascia, Silvia Grazietta Foddai, Cristiano Alessandri, Alessia Alunno, Laura Andreoli, Alice Barinotti, Antonia Calligaro, Valentina Canti, Francesco Carubbi, Irene Cecchi, Cecillia B Chighizola, Fabrizio Conti, Giacomo Emmi, Antonella Fioravanti, Fabio Fischetti, Franco Franceschini, Maria Gerosa, Ariela Hoxha, Maddalena Larosa, Maria-Grazia Lazzaroni, Cecilia Nalli, Giulia Pazzola, Massimo Radin, Bernd Raffeiner, Veronique L Ramoni, Elena Rubini, Gian Domenico Sebastiani, Simona Truglia, Maria Letizia Urban, Dario Roccatello, Angela Tincani
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2318/1874878
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