Background and Aims

Recent studies suggest that multiple positivity of antiphospholipid antibodies (aPL) in antiphospholipid syndrome (APS) is more frequently associated with thromboembolic events than a single positive test. EULAR recommendations suggest that aPL profile (high or low risk) is defined by the presence of multiple versus single aPL type, the titre (moderate-high titre vs low) and the persistence of aPL positivity in repeated measurements. aPL might disappear in some patients during follow-up but little is known about thrombotic recurrence risk in those patients in whom anticoagulation withdrawal could be considered.

To identify and include study articles that reported clinical experience of thrombotic APS patients with aPL persistently negative in whom antithrombotic treatment was withdrawn.

Methods

A systematic review was performed and included articles that reported clinical experience of APS patients with aPL persistently negative and that anticoagulation was stopped for that reason

Results

We identified 6 studies. 22 subjects (mean age 35 ± 11 years, 86,3% female) were included into the final analysis. Seventeen patients had thrombosis (1 arterial), 4 were obstetric APS and only patient had both. Regarding aPL profile, fourteen had single positivity, 7 double and one patient was triple positivity. Patients received treatment a median of 72 months (IQR 31-120). After a median of 27,5 months (IQR 13,5-60) of follow-up after anticoagulation withdrawal, no thrombotic events were observed in 95% of patients.

Conclusions

Results seem to suggest that it is possible to discontinue antithrombotic treatment in some patients with low risk aPL profile and primary APS whom aPL became persistently negative overtime.