Descriptive analysis of the Nationwide START2 antiphospholipid registry: Clinical and laboratory characteristics of patients with persistently positive antiphospholipid antibodies

IF 3.4 3区医学 Q1 HEMATOLOGY

Thrombosis research Pub Date : 2026-08-01 Epub Date: 2026-07-17 DOI:10.1016/j.thromres.2026.109786

Vittorio Pengo, Daniela Poli, Luca Sarti, Piera Sivera, Doris Barcellona, Domenico Prisco, Attilia Maria Pizzini, Giuseppe Vercillo, Emilia Antonucci, Gualtiero Palareti

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Abstract

Background

The clinical significance of persistently positive antiphospholipid antibodies (aPLs) remains incompletely defined.

Objectives

To describe the clinical and laboratory characteristics of patients with confirmed aPL positivity enrolled in the nationwide START2 Antiphospholipid Registry.

Methods

Adult patients were included if all three laboratory tests—Lupus Anticoagulant (LA), anticardiolipin antibodies (aCL), and anti-β2-glycoprotein I antibodies (aβ2GPI)—were performed and confirmed after ≥12 weeks. Patients were categorized as Antiphospholipis Syndrome (APS) or aPL carriers. Clinical manifestations, non-criteria features, laboratory profiles, associated risk factors, and antithrombotic treatments were analyzed descriptively.

Results

Among 500 enrolled patients, 341 were classified as APS and 159 as carriers. Women were overrepresented among carriers (76% vs 62%, p = 0.002). APS patients displayed a higher prevalence of non-criteria manifestations, largely driven by renal involvement in those with SLE. Laboratory profiles were similarly distributed across APS and carriers: triple positivity (43% vs 44%), double positivity (13% vs 12%), and isolated LA positivity (23% vs 30%). Venous thromboembolism (VTE) occurred more frequently in APS patients LA-positive only (67%, p = 0.004), while arterial thrombosis was more evenly distributed across profiles. After a first VTE, most APS patients received warfarin (62%), whereas arterial APS was treated with either warfarin (51%) or aspirin (37%). Among carriers, aspirin was the preferred prophylactic strategy (45%).

Conclusions

Triple, double, and LA positive only represent the most common laboratory patterns. LA positivity omly shows a disproportionately high rate of VTE. Non-criteria manifestations remain more common in APS. Substantial variability persists in antithrombotic management, underscoring the need for prospective treatment trials.

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全国START2抗磷脂登记的描述性分析：抗磷脂抗体持续阳性患者的临床和实验室特征

背景：抗磷脂抗体（apl）持续阳性的临床意义仍不完全明确。目的：描述在全国START2抗磷脂注册中心登记的aPL阳性患者的临床和实验室特征。方法：在≥12周后进行红斑狼疮抗凝血（LA）、抗心磷脂抗体（aCL）和抗β2-糖蛋白I抗体（a -β 2gpi）三项实验室检查并确认的成年患者纳入研究。患者分为抗磷脂综合征（APS）和aPL携带者。对临床表现、非标准特征、实验室资料、相关危险因素和抗血栓治疗进行描述性分析。结果：500例入组患者中，341例为APS， 159例为携带者。女性在携带者中比例过高（76% vs 62%, p = 0.002）。APS患者表现出更高的非标准表现，主要是由SLE患者的肾脏受累所致。实验室资料在APS和携带者中分布相似：三重阳性（43%对44%），双重阳性（13%对12%）和孤立的LA阳性（23%对30%）。静脉血栓栓塞（VTE）在la阳性APS患者中发生率更高（67%,p = 0.004），而动脉血栓形成在各剖面中分布更均匀。在第一次静脉血栓栓塞后，大多数APS患者接受华法林治疗（62%），而动脉APS患者接受华法林（51%）或阿司匹林（37%）治疗。在携带者中，阿司匹林是首选的预防策略（45%）。结论：三、双、LA阳性仅代表最常见的实验室模式。LA阳性仅表明静脉血栓栓塞率过高。非标准表现在APS中更为常见。在抗血栓治疗方面，存在很大的变异性，这强调了前瞻性治疗试验的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Thrombosis research 医学-外周血管病

CiteScore

14.60

自引率

4.00%

发文量

364

审稿时长

31 days

期刊介绍： Thrombosis Research is an international journal dedicated to the swift dissemination of new information on thrombosis, hemostasis, and vascular biology, aimed at advancing both science and clinical care. The journal publishes peer-reviewed original research, reviews, editorials, opinions, and critiques, covering both basic and clinical studies. Priority is given to research that promises novel approaches in the diagnosis, therapy, prognosis, and prevention of thrombotic and hemorrhagic diseases.