Abstract
Purpose
Antiphospholipid Antibody Syndrome (APS) is a complex autoimmune disorder that includes
a combination of laboratory criteria and clinical events (thrombosis, pregnancy complications).
Accurate classification is essential, as APS patients may have limited oral anticoagulant
options and requires indefinite anticoagulation. The prevalence of inaccurate APS
misclassification is unknown. This study sought to determine the proportion of patients
in an academic health-system who formally met APS criteria.
Methods
This retrospective cohort study included any patient within the University of Utah
Health system who had an International Classification of Diseases-10 code for APS,
between January 1, 2016 and June 30, 2020. Manual chart review was performed to assess
the appropriateness of the APS classification by laboratory and clinical criteria.
Results
Of the 184 patients identified, 59 (32.1 %) formally met APS criteria, while 69 (37.5 %)
did not meet criteria. The remaining 56 (30.4 %) patients lacked enough information
in their medical records to decide on appropriateness of APS classification. The most
prevalent reason for inappropriate APS classification in the 69 patients identified
was incorrect interpretation of lab values as positive (62; 89.9 %), followed by lack
of repeat confirmation testing (32; 46.4 %).
Conclusion
The results of this single-center study indicate that only one-third of patients with
presumed APS met classification criteria. This was predominantly due to incorrect
collection or interpretation of APS laboratory data. One-third had insufficient medical
record data to determine APS classification, which impairs clinical decision-making.
This suggests more education or implementation of anticoagulation stewardship is needed
to ensure accurate APS classification and proper management of anticoagulation therapy.
Keywords
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Article info
Publication history
Published online: November 17, 2022
Accepted:
November 11,
2022
Received in revised form:
October 12,
2022
Received:
August 9,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
