Prevalence Rates of Antiphospholipid Antibodies in Ischemic Stroke Patients

ABSTRACT:Background:Antibodies to cardiolipin and other phospholipids have been associated with recurrent thrombotic events, including stroke.Methods:Over a 16 month period we assessed an unselected cohort of 151 ischemic stroke patients for the presence of antiphospholipid antibodies. Patients with known systemic lupus erythematosis, systemic sclerosis, or Sjogrens Syndrome were excluded. Sera from patients admitted to hospital with a diagnosis of ischemic stroke (n = 151) and from controls (n = 111) assessed during the same period were tested for antiphospholipid antibodies (APLA) using 3 assays; anticardiolipin antibodies (ACA) by ELISA, prolonged activated partial thromboplastin time (APTT), and VDRL.Results:The average age of ischemic stroke cases was 68 years (range 29 to 91) and of controls 63 years (range 29 to 86). The prevalence of APLA detected by at least one of the three methods was 12% for IS cases and 10% for controls. After correcting for known risk factors such as age, gender, diabetes mellitus, heart disease, hypertension, and smoking, the odds ratio for risk of stroke fell to 0.8 (C.I. 0.4 to 1.2).Conclusions:Our findings suggest that APLA may not be an independent risk factor for ischemic stroke in unselected persons who do not have known systemic lupus erythematosis or systemic sclerosis but further evaluation of the role of lupus anticoagulant is indicated.

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Classical and additional antiphospholipid antibodies in blood samples of ischemic stroke patients and healthy controls

Immunologic Research ◽

10.1007/s12026-017-8897-z ◽

2017 ◽

Vol 65 (2) ◽

pp. 470-476 ◽

Cited By ~ 2

Author(s):

Narin-Nard Carmel-Neiderman ◽

David Tanne ◽

Idan Goren ◽

Pnina Rotman-Pikielny ◽

Yair Levy

Keyword(s):

Ischemic Stroke ◽

Antiphospholipid Antibodies ◽

Healthy Controls ◽

Stroke Patients ◽

Blood Samples

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Investigation of Antiphosphatidyl-Serine Antibody and Antiphosphatidyl-Inositol Antibody in Ischemic Stroke Patients

Clinical and Developmental Immunology ◽

10.1155/2010/439230 ◽

2010 ◽

Vol 2010 ◽

pp. 1-4 ◽

Cited By ~ 4

Author(s):

Hirohisa Okuma ◽

Yasuhisa Kitagawa ◽

Shigeharu Takagi

Keyword(s):

Ischemic Stroke ◽

Carotid Artery ◽

Venous Thrombosis ◽

Antiphospholipid Syndrome ◽

Carotid Artery Stenosis ◽

Antiphospholipid Antibodies ◽

Antinuclear Antibody ◽

Artery Stenosis ◽

Stroke Patients ◽

Intimal Medial Thickness

Antiphospholipid syndrome is characterized by arterial or venous thrombosis and the presence of antiphospholipid antibodies (aPL). We measured β2-GPI aCL, IgGaCL, LA, antiphosphatidyl-serine antibody (PS), and antiphosphatidyl-inositol antibody (PI) in each patient at one month after the onset of stroke. In addition, carotid artery echography was performed in patients positive for PI or PS. Among the 250 patients, 13.6% (34/250) were positive for either PI or PS, and 6.8% (17/250) were positive for both. Carotid artery echography performed on these 34 patients showed that the frequencies of increased intimal-medial thickness (IMT) of 1.1 mm or more, plaque, and carotid artery stenosis of 50% or more were all significantly higher in patients positive for antinuclear antibody than those negative for the antibody (P<.05). PI and PS are associated with antinuclear antibody and precipitation of atherosclerosis. Ischemic stroke patients with SLE frequently showed a variety of antiphospholipid-protein antibodies.

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Presence of Extra-Criteria Antiphospholipid Antibodies Is an Independent Risk Factor for Ischemic Stroke

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.665741 ◽

2021 ◽

Vol 8 ◽

Author(s):

Laura Naranjo ◽

Fernando Ostos ◽

Francisco Javier Gil-Etayo ◽

Jesús Hernández-Gallego ◽

Óscar Cabrera-Marante ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Ischemic Stroke ◽

Cardiovascular Risk ◽

General Population ◽

Antiphospholipid Antibodies ◽

Independent Risk Factor ◽

Thrombotic Event ◽

Reference Population ◽

Stroke Patients

Background: Ischemic stroke is the most common and severe arterial thrombotic event in Antiphospholipid syndrome (APS). APS is an autoimmune disease characterized by the presence of thrombosis and antiphospholipid antibodies (aPL), which provide a pro-coagulant state. The aPL included in the classification criteria are lupus anticoagulant, anti-cardiolipin (aCL) and anti-β2-glycoprotein-I antibodies (aB2GPI) of IgG and IgM isotypes. Extra-criteria aPL, especially IgA aB2GPI and IgG/IgM anti-phosphatidylserine/prothrombin antibodies (aPS/PT), have been strongly associated with thrombosis. However, their role in the general population suffering from stroke is unknown. We aim (1) to evaluate the aPL prevalence in ischemic stroke patients, (2) to determine the role of aPL as a risk factor for stroke, and (3) to create an easy-to-use tool to stratify the risk of ischemic stroke occurrence considering the presence of aPL and other risk factors.Materials and Methods: A cohort of 245 consecutive ischemic stroke patients was evaluated in the first 24 h after the acute event for the presence of classic aPL, extra-criteria aPL (IgA aB2GPI, IgG, and IgM aPS/PT) and conventional cardiovascular risk factors. These patients were followed-up for 2-years. A group of 121 healthy volunteers of the same age range and representative of the general population was used as reference population. The study was approved by the Ethics Committee for Clinical Research (Reference numbers CEIC-14/354 and CEIC-18/182).Results: The overall aPL prevalence in stroke patients was 28% and IgA aB2GPI were the most prevalent (20%). In the multivariant analysis, the presence of IgA aB2GPI (OR 2.40, 95% CI: 1.03–5.53), dyslipidemia (OR 1.70, 95% CI: 1.01–2.84), arterial hypertension (OR 1.82, 95% CI: 1.03–3.22), atrial fibrillation (OR 4.31, 95% CI: 1.90–9.78), and active smoking (OR 3.47, 95% CI: 1.72–6.99) were identified as independent risk factors for ischemic stroke. A risk stratification tool for stroke was created based on these factors (AUC: 0.75).Conclusions: IgA aB2GPI are an important independent risk factor for ischemic stroke. Evaluation of aPL (including extra-criteria) in cardiovascular risk factor assessment for stroke can potentially increase the identification of patients at risk of thrombotic event, facilitating a decision on preventive treatments.

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