Antiphospholipid Syndrome: Clinical Advances in Diagnosis and Management

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Immunology".

Deadline for manuscript submissions: 15 September 2025 | Viewed by 2600

Special Issue Editors


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Guest Editor
Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
Interests: cardiology; thrombosis; coagulation; antiplatelet therapy; anticoagulant therapy

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Guest Editor
Rheumatology Unit, Department of Clinical Internal, Anesthetic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
Interests: antiphospholipid syndrome; antiphospholipid antibodies; systemic lupus erythematosus; immunosuppressive therapy; diagnosis; management

Special Issue Information

Dear Colleagues,

Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by the presence of antiphospholipid antibodies, which predispose individuals to arterial and venous thrombosis as well as pregnancy complications. This syndrome can occur either in isolation (primary APS) or in conjunction with other autoimmune diseases, most notably systemic lupus erythematosus (secondary APS).

Recent clinical advances have revolutionized both the diagnosis and management of antiphospholipid syndrome (APS). However, these remain a challenge for clinicians.

This Special Issue is dedicated to the critical contributions of hematologists, rheumatologists, obstetricians, and other specialists for comprehensive management and improving long-term outcomes in patients with APS. The aim of this Special Issue, which will include original papers and reviews, is to provide an up-to-date overview of advances and progress in the treatment of APS, which will aid in the accurate diagnosis and management of this devastating disease to prevent its harmful consequences.

Dr. Mattia Galli
Dr. Alessandra Ida Celia
Guest Editors

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Keywords

  • antiphospholipid syndrome
  • antiphospholipid antibodies
  • systemic lupus erythematosus
  • immunosuppressive therapy
  • diagnosis
  • management

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Published Papers (3 papers)

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Research

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15 pages, 955 KiB  
Article
Pregnancy Outcomes in Non-Criteria Obstetric Antiphospholipid Syndrome: Analysis of a Cohort of 91 Patients
by Sara Beça, Núria Baños, Maria Borrell, Estíbaliz Ruiz-Ortiz, Albert Pérez-Isidro, Ricard Cervera, Joan Carles Reverter, Dolores Tàssies and Gerard Espinosa
J. Clin. Med. 2024, 13(24), 7862; https://doi.org/10.3390/jcm13247862 - 23 Dec 2024
Viewed by 1166
Abstract
Background: The clinical and laboratory features of patients with non-criteria obstetric antiphospholipid syndrome (NC-OAPS), as well as their pregnancy outcomes and ideal treatment are not clearly determined. The aim of this study is to describe the characteristics and outcomes of pregnancies in [...] Read more.
Background: The clinical and laboratory features of patients with non-criteria obstetric antiphospholipid syndrome (NC-OAPS), as well as their pregnancy outcomes and ideal treatment are not clearly determined. The aim of this study is to describe the characteristics and outcomes of pregnancies in NC-OAPS and compare them with an obstetric APS (OAPS) cohort. Methods: This is a retrospective study conducted on a cohort of women referred to a high-risk obstetric unit of a tertiary hospital. Women that were classified as having OAPS or NC-OAPS were included and compared in terms of clinical and laboratory characteristics, management, and subsequent pregnancy outcomes. Results: We identified 107 women with 143 pregnancies, 91 with NC-OAPS and 16 with OAPS. There were no differences in demographic features between both groups. Women with NC-OAPS were more likely to have recurrent implantation failure and were predominantly positive for a single antiphospholipid antibody (aPL) subtype. Both groups were treated similarly (low dose aspirin plus low molecular weight heparin in 87.4% of NC-OAPS and 83.3% of OAPS, p > 0.05). Live birth rate (82.4% and 75.0%, respectively, p > 0.05) and adverse pregnancy outcomes (31.6% vs. 37.5%, p > 0.05) in subsequent pregnancies during follow-up were also similar between groups. Conclusions: This study revealed differences in the previous pregnancy morbidity and aPL profiles in women with NC-OAPS and OAPS, although the therapeutic approach and the outcomes of subsequent pregnancies were similar in both groups. Full article
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Review

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12 pages, 1071 KiB  
Review
Update on the Laboratory Diagnosis of Lupus Anticoagulant: Current Challenges and Clinical Involvement
by Ana Marco-Rico
J. Clin. Med. 2025, 14(8), 2791; https://doi.org/10.3390/jcm14082791 - 18 Apr 2025
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Abstract
Lupus anticoagulant (LAC) is a heterogeneous mix of autoimmune antibodies that prolongs phospholipid-dependent clotting assays. Its diagnosis can be a real challenge in the hemostasis laboratory. In this review, the author describes the main pitfalls affecting the preanalytical phase and how to proceed [...] Read more.
Lupus anticoagulant (LAC) is a heterogeneous mix of autoimmune antibodies that prolongs phospholipid-dependent clotting assays. Its diagnosis can be a real challenge in the hemostasis laboratory. In this review, the author describes the main pitfalls affecting the preanalytical phase and how to proceed to reduce interferences. Because of the heterogeneity of these autoantibodies, two assays with different mechanism of action should be performed to detect the majority of LACs. The dilute Russell’s viper venom test and the use of a reagent very sensitive to LAC derived from the activated partial thromboplastin time, using silica as the activator, are the most frequent techniques. The algorithms for LAC detection are reported here, and every laboratory is encouraged to introduce its own diagnostic procedure. Results should be expressed in ratio to reduce inter- and intravariability. In addition, the effect of anticoagulation in LAC assays and possible strategies for a correct diagnosis are provided. Full article
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19 pages, 5686 KiB  
Review
Non-Criteria Obstetric Antiphospholipid Syndrome: Myth or Reality?
by Sara Beça, Maria Borrell, Ricard Cervera, Francesc Figueras, Alfons Nadal, Gerard Espinosa and Núria Baños
J. Clin. Med. 2025, 14(4), 1299; https://doi.org/10.3390/jcm14041299 - 15 Feb 2025
Viewed by 745
Abstract
Women with adverse pregnancy outcomes suggestive of obstetric antiphospholipid syndrome (OAPS), but not fulfilling clinical and/or laboratory international classification criteria, are increasingly recognized both in clinical practice and in the literature. This entity is termed non-criteria OAPS (NC-OAPS). It includes clinical scenarios such [...] Read more.
Women with adverse pregnancy outcomes suggestive of obstetric antiphospholipid syndrome (OAPS), but not fulfilling clinical and/or laboratory international classification criteria, are increasingly recognized both in clinical practice and in the literature. This entity is termed non-criteria OAPS (NC-OAPS). It includes clinical scenarios such as two unexplained pregnancy losses, three non-consecutive pregnancy losses, late pre-eclampsia/eclampsia/signs of placental insufficiency, or recurrent implantation failure, as well as positive low-titers of antiphospholipid antibodies (aPLs) and non-classical aPLs. To address the NC-OAPS heterogeneity, a nomenclature proposal was developed. In recent years, retrospective and prospective cohort studies have been designed to clarify the characteristics and outcomes of the different subsets of NC-OAPS. In general, the studies support that NC-OAPS may benefit from treatment with antithrombotic, anticoagulant and/or immunomodulator agents, but several considerations must be made on the robustness and nuances of the scientific evidence. The objective of this review is to critically analyze the available evidence supporting the diagnosis of NC-OAPS, categorize its subsets, and evaluate the impact of treatment strategies on its outcome. We also remark on questions that are still unanswered, such as the lack of consensus on diagnostic criteria or treatment protocols. Full article
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