Antiphospholipid antibodies and cardiovascular thrombosis.
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Rashedi Sina, Leyva Hannah, Siddiqui Saman A, Bukhari Syed, Pfeferman Mariana B, Watson Nathan W, Ujueta Francisco, Zarghami Mehrdad, Bacare Bassil, Kanthi Yogendra, Jimenez David, Monreal Manuel, Siegal Deborah M, Barnes Geoffrey D, Eikelboom John W, O'Donoghue Michelle L, Ruff Christian T, Galli Mattia, Weber Brittany N, Goldhaber Samuel Z, Uljon Sacha, Middeldorp Saskia, Lopes Renato D, Garcia David A, Lip Gregory Y H, Weitz Jeffery I, Connors Jean M, Krumholz Harlan M, Knight Jason S, Lippi Giuseppe, Elkind Mitchell S V, Cushman Mary, Costenbader Karen H, Piazza Gregory, Bikdeli Behnood
Аннотация
Antiphospholipid antibodies (aPL) are directed against phospholipids and phospholipid-binding proteins. Laboratory assays used to detect aPL include serological tests for aPL against β2-glycoprotein 1, cardiolipin and other molecules, as well as functional assays for lupus anticoagulant. The presence of aPL can lead to endothelial dysfunction or a hypercoagulable state through prothrombotic and antifibrinolytic mechanisms. These processes, often in conjunction with a 'second hit', such as trauma, surgery, or other causes of hypercoagulability or stasis, can lead to venous or arterial thrombosis. The thrombotic risk associated with aPL is best recognized in thrombotic antiphospholipid syndrome, characterized by a persistently positive test for lupus anticoagulant or seropositivity for aPL associated with venous, arterial or microvascular thrombosis. However, aPL seropositivity and its clinical effect on thrombotic events have been increasingly recognized in a broader group of individuals who do not meet traditional research criteria for thrombotic antiphospholipid syndrome. In this Review, we provide an overview of the evidence related to aPL seropositivity in individuals with or without previous thrombosis and the clinical relevance of aPL seropositivity in predicting the risk of thrombotic cardiovascular events. We discuss potential management strategies and identify key knowledge gaps that warrant further research.