Identifying Parameters Associated with Delayed Diagnosis in Thrombotic Antiphospholipid Syndrome: Data from China Prospective APS Cohort

Introduction

The aim of this study was to  evaluate the rate of delayed diagnosis in patients with thrombotic antiphospholipid syndrome (tAPS) and explore potential risk factors and prognosis of delayed diagnosis.

Methods

This single-center, prospective study included consecutive patients with tAPS fulfilling the 2006 Sydney Revised Classification Criteria referred to Peking Union Medical College Hospital from June 2012 to September 2022. Patients diagnosed after more than two aPL-related clinical events had occurred were defined as having delayed diagnosis. Logistic regression analysis was used to identify risk factors, and survival analysis was employed to assess prognosis.

Results

A total of 379 patients were enrolled in the study. The mean age was 32.35 ± 13.86 years old, and 221 were female (58.31%), with venous thromboembolism occurring in 174 (45.91%) patients as the first event and arterial thrombosis in 107 (28.23%). Two hundred fifty-four (67.02%) patients had delayed diagnosis. Three high-frequency contributors for delay were obstetric morbidity (39.68%), deep vein thrombosis (26.38%), and thrombocytopenia (19.69%). Multivariate logistic regression indicated that patients with cardiovascular risk factors were more likely to receive delayed diagnosis (odds ratio [OR] = 1.767, 95% confidence interval [CI] 1.129–2.767, P = 0.013). Thrombocytopenia as first events (OR = 2.277, 95% CI 1.159–4.474, P = 0.017) was also a risk factor. Survival analysis showed that APS-related clinical manifestations and thrombotic recurrence were more likely to occur in delayed diagnosis group.

Conclusion

Delayed diagnosis of tAPS is common, which may lead to poor prognosis. For patients with cardiovascular risk factors and non-criteria manifestations, physicians should be alert to the possibility of APS.