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Current status and value of testing antiphospholipid antibody in patients with acute ischemic stroke: a retrospective single-center study in China

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Abstract

Background and purpose

Testing for antiphospholipid antibodies (aPL) is useful to determine the cause of ischemic stroke in young and female patients. However, the clinical relevance of aPL in older patients with ischemic stroke remains unclear. We aimed to explore the status and diagnostic value of initial aPL testing in all patients with acute ischemic stroke.

Methods

We retrospectively analyzed patients with acute ischemic stroke who were consecutively hospitalized in our hospital between June 2012 and January 2022 and investigated the factors associated with performing aPL screening in real-world clinical practice. Furthermore, factors associated with initial aPL positivity were evaluated by comparing the demographic, etiological, and therapeutic characteristics.

Results

Of 1209 patients, 287 (23.7%) were tested for aPL and 58 (20.2%) tested positive. Physicians tended to conduct aPL testing on female patients (P<0.001), younger patients (P<0.001), patients with fewer vascular risk factors (P<0.001), and multiple infarctions in the multivascular blood supply area (P<0.001). Multivariate logistic regression analysis showed that only stroke of other determined etiology type was a significant influencing factor for positive aPL results (OR 2.97, 95% CI 1.137, 7.774, P=0.026), adjusting for sex, age, and causes of stroke, etc.

Conclusion

Approximately one-quarter of the patients with acute ischemic stroke were tested for aPL. Age, sex, number of vascular risk factors, and neuroimaging features affected the discretion in performing aPL testing. aPL testing may be appropriate in older patients with no identified cause of ischemic stroke and may provide additional diagnostic opportunities for acute ischemic stroke.

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Data availability

The datasets generated and analyzed during the current study are available from the corresponding authors on reasonable request.

References

  1. GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the global burden of disease study 2019 (2021) Lancet Neurol 20(10):795–820. https://doi.org/10.1016/S1474-4422(21)00252-0

    Article  Google Scholar 

  2. Adams HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE (1993) Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 24(1):35–41. https://doi.org/10.1161/01.STR.24.1.35

    Article  PubMed  Google Scholar 

  3. Diener H-C, Easton JD, Hart RG, Kasner S, Kamel H, Ntaios G (2022) Review and update of the concept of embolic stroke of undetermined source. Nat Rev Neurol 18(8):455–465. https://doi.org/10.1038/s41582-022-00663-4

    Article  CAS  PubMed  Google Scholar 

  4. Stevens SM, Woller SC, Bauer KA, Kasthuri R, Cushman M, Streiff M, Lim W, Douketis JD (2016) Guidance for the evaluation and treatment of hereditary and acquired thrombophilia. J Thromb Thrombolysis 41(1):154–164. https://doi.org/10.1007/s11239-015-1316-1

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Tuhrim S (2004) Antiphospholipid antibodies and stroke. Curr Cardiol Rep 6(2):130–134. https://doi.org/10.1007/s11886-004-0011-1

    Article  PubMed  Google Scholar 

  6. Brey RL, Chapman J, Levine SR, Ruiz-Irastorza G, Derksen RH, Khamashta M, Shoenfeld Y (2003) Stroke and the antiphospholipid syndrome: consensus meeting Taormina 2002. Lupus 12(7):508–513. https://doi.org/10.1191/0961203303lu390oa

    Article  CAS  PubMed  Google Scholar 

  7. Garcia D, Erkan D (2018) Diagnosis and management of the antiphospholipid syndrome. N Engl J Med 378(21):2010–2021. https://doi.org/10.1056/NEJMra1705454

    Article  CAS  PubMed  Google Scholar 

  8. Naranjo L, Ostos F, Gil-Etayo FJ, Hernández-Gallego J, Cabrera-Marante Ó, Pleguezuelo DE, Díaz-Simón R, Cerro M, Lora D, Martínez-Salio A, Serrano A (2021) presence of extra-criteria antiphospholipid antibodies is an independent risk factor for ischemic stroke. Front Cardiovasc Med 8:665741. https://doi.org/10.3389/fcvm.2021.665741

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Gavva C, Johnson M, De Simone N, Sarode R (2018) An audit of thrombophilia testing in patients with ischemic stroke or transient ischemic attack: the futility of testing. J Stroke and Cerebrovasc Dis 27(11):3301–3305. https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.07.032

    Article  Google Scholar 

  10. Markus HS, Hambley H (1998) Neurology and the blood: haematological abnormalities in ischaemic stroke. J Neurol Neurosurg Psychiatry 64(2):150–159. https://doi.org/10.1136/jnnp.64.2.150

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Bushnell CD, Goldstein LB (2000) Diagnostic testing for coagulopathies in patients with ischemic stroke. Stroke 31(12):3067–3078. https://doi.org/10.1161/01.str.31.12.3067

    Article  CAS  PubMed  Google Scholar 

  12. Rahemtullah A, Van Cott EM (2007) Hypercoagulation testing in ischemic stroke. Arch Pathol Lab Med 131(6):890–901. https://doi.org/10.5858/2007-131-890-HTIIS

    Article  CAS  PubMed  Google Scholar 

  13. Brey RL, Stallworth CL, McGlasson DL, Wozniak MA, Wityk RJ, Stern BJ, Sloan MA, Sherwin R, Price TR, Macko RF, Johnson CJ, Earley CJ, Buchholz DW, Hebel JR, Kittner SJ (2002) Antiphospholipid antibodies and stroke in young women. Stroke 33(10):2396–2401. https://doi.org/10.1161/01.STR.0000031927.25510.D1

    Article  CAS  PubMed  Google Scholar 

  14. Urbanus RT, Siegerink B, Roest M, Rosendaal FR, de Groot PG, Algra A (2009) Antiphospholipid antibodies and risk of myocardial infarction and ischaemic stroke in young women in the RATIO study: a case-control study. Lancet Neurol 8(11):998–1005. https://doi.org/10.1016/S1474-4422(09)70239-X

    Article  CAS  PubMed  Google Scholar 

  15. Alakbarzade V, Taylor A, Scully M, Simister R, Chandratheva A (2018) Utility of current thrombophilia screening in young patients with stroke and TIA. Stroke Vasc Neurol 3(4):231–236. https://doi.org/10.1136/svn-2018-000169

    Article  PubMed  PubMed Central  Google Scholar 

  16. Vlagea A, Pascual-Salcedo D, Álvarez Doforno R, Lavilla P, Diez J, Padilla Merlano B, Cuesta MV, Gil A (2018) IgA anti-Β2 glycoprotein I antibodies: experience from a large center. Thromb Res 162:38–43. https://doi.org/10.1016/j.thromres.2017.12.007

    Article  CAS  PubMed  Google Scholar 

  17. Su Z, Huang Z, Zhao J, Li M, Hu J, Zeng X, Hu C, Yang B (2022) Detection of IgA antiphospholipid antibodies does not improve thrombotic antiphospholipid syndrome classification: a two-center study. Clin Appl Thromb Hemost 28. https://doi.org/10.1177/10760296221081129

  18. García-Grimshaw M, Posadas-Pinto DR, Jiménez-Ruiz A, Valdés-Ferrer SI, Cadena-Fernández A, Torres-Ruiz JJ, Barrientos-Guerra JD, Amancha-Gabela M, Chiquete E, Flores-Silva FD, Cantú-Brito C (2022) Antiphospholipid syndrome–mediated acute cerebrovascular diseases and long-term outcomes. Lupus 31(2):228–237. https://doi.org/10.1177/09612033221074178

    Article  CAS  PubMed  Google Scholar 

  19. Levine SR, Brey RL, Tilley BC, Thompson JLP, Sacco RL, Sciacca RR, Murphy A, Lu Y, Costigan TM, Rhine C, Levin B, Triplett DA, Mohr JP (2004) APASS investigators. Antiphospholipid antibodies and subsequent thrombo-occlusive events in patients with ischemic stroke. JAMA 291(5):576–584. https://doi.org/10.1001/jama.291.5.576

    Article  CAS  PubMed  Google Scholar 

  20. Yang W, Kang MK, Ha SY, Kang D, Bae J, Lee E, Jeong H, Kim J, Jung K, Lee S (2022) Current status and role of antiphospholipid antibody testing in cryptogenic stroke. Euro J Neurology 29(3):753–760. https://doi.org/10.1111/ene.15191

    Article  Google Scholar 

  21. Yang W, Kang D-W, Kim J-M, Jung K-H, Lee S-H (2022) Neuroimaging features of antiphospholipid antibody-related stroke compared with atrial fibrillation-related stroke. Sci Rep:12. https://doi.org/10.1038/s41598-022-16019-3

  22. Kempers EK, Dalm VASH, van Rijn MJE, Mulders AGMGJ, Leebeek FWG, de Maat MPM, Jansen AJG (2021) Indication and outcome of lupus anticoagulant and antiphospholipid antibodies testing in routine clinical practice. Rheumatol Adv Pract 5(3):rkab093. https://doi.org/10.1093/rap/rkab093

    Article  PubMed  PubMed Central  Google Scholar 

  23. Bu X, Peng H, Zhong C, Xu T, Xu T, Peng Y, Chen C-S, Wang J, Ju Z, Li Q, Geng D, Sun Y, Zhang D, Zhang J, Chen J, Zhang Y, He J (2016) Antiphosphatidylserine antibodies and clinical outcomes in patients with acute ischemic stroke. Stroke 47(11):2742–2748. https://doi.org/10.1161/STROKEAHA.116.013827

    Article  CAS  PubMed  Google Scholar 

  24. Žigon P, Podovšovnik A, Ambrožič A, Tomšič M, Hočevar A, Gašperšič N, Rotar Ž, Praprotnik S, Šemrl SS, Čučnik S (2019) Added value of non-criteria antiphospholipid antibodies for antiphospholipid syndrome: lessons learned from year-long routine measurements. Clin Rheumatol 38(2):371–378. https://doi.org/10.1007/s10067-018-4251-7

    Article  PubMed  Google Scholar 

  25. Rodríguez-Sanz A, Martínez-Sánchez P, Prefasi D, Fuentes B, Pascual-Salcedo D, Blanco-Bañares MJ, Díez-Tejedor E (2015) Antiphospholipid antibodies correlate with stroke severity and outcome in patients with antiphospholipid syndrome. Autoimmunity 48(5):275–281. https://doi.org/10.3109/08916934.2014.988329

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank all patients for participating in the project and all the staff for the time and effort they devoted.

Funding

This study was supported by STI2030-Major Project #2021ZD0201100 Task 5 #2021ZD0201105.

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Author notes

  1. Qiqi Wang and Guangsong Han contributed equally to this work and share first authorship.

Authors and Affiliations

  1. Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China

    Qiqi Wang, Guangsong Han, Yuhui Sha, Mingyu Tang, Ziang Pan, Yicheng Zhu, Lixin Zhou & Jun Ni

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  1. Qiqi Wang
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Contributions

Study concept and design: JN and LZ

Data collection and analysis: GH, YS, MT, ZP

Manuscript drafting: QW and GH

Critical revision of the manuscript for intellectual content: JN and LZ

Corresponding authors

Correspondence to Lixin Zhou or Jun Ni.

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Ethical approval

This study followed the Strengthening the Reporting of Observational Studies in Epidemiology reporting guidelines. This study was approved by the ethical review board of Peking Union Medical College Hospital.

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All authors agreed to the submission.

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The authors declare no competing interests.

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Wang, ., Han, G., Sha, Y. et al. Current status and value of testing antiphospholipid antibody in patients with acute ischemic stroke: a retrospective single-center study in China. Neurol Sci 45, 1121–1128 (2024). https://doi.org/10.1007/s10072-023-07054-7

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