Presentation Details
Reclassification of Antiphospholipid Antibody Syndrome According to the 2023 ACR/EULAR Guidance in a Pharmacist Directed Anticoagulation Clinic

Catherine DeFazio1, Lara Horvath1, Jennifer Morgan1, Meaghan Murphy1, Ashley Shtoyko1, Elizabeth Phillips2.

1SUNY Upstate Medical University, Syracuse, NY, USA.2St.John Fisher University, Wegmans School of Pharmacy, Rochester, NY, USA

Abstract


Background: Antiphospholipid antibody syndrome (APS) is a complex medical condition that places patients at high risk for thrombosis and associated outcomes. Identifying patients with APS can be challenging as the diagnostic criteria includes clinical and laboratory components that have various nuances. Additionally, anticoagulation management in patients with APS is limited to warfarin, a high-risk medication that requires frequent monitoring and dose adjustments. In 2023, ACR/EULAR published updated APS classification criteria. These criteria highlight new considerations in the clinical and laboratory domains for classification of APS. A weighted value is assigned to each domain in order to classify a patient based on their lab results and clinical scenario, warranting review of current patient panels.    Objectives: The primary objective was to determine the number of patients that met classification criteria for APS after applying the 2023 ACR/EULAR guidelines. The secondary objectives were to identify the reason patients did not meet criteria for APS according to the new guidance and to determine the number of patients who were single, double, or triple positive based on lab criteria.    Methods: This was a single center, retrospective chart review of patients with APS on anticoagulation actively managed by the ambulatory care clinical pharmacy team via collaborative drug therapy management agreements as of October 1st, 2023. The study was deemed exempt from the Upstate University Hospital Institutional Review Board.  Data collected included patient demographics, type of anticoagulation, and clinical and laboratory criteria for APS as defined by the 2023 ACR/EULAR guidance. Data is presented using descriptive statistics.     Results: A total of 51 patients previously diagnosed with APS were included in the study. Of the 51 patients, 22 were male (43.1%) and 29 were female (56.8%). Ages ranged from 26 to 79 years old with an average age of 51 years old. There were 42 patients on warfarin (82.3%), four patients on direct oral anticoagulants (19%), three patients on low molecular weight heparin (5.8%), and two patients on fondaparinux (3.9%). Of the 51 patients, 11 (21.5%) met reclassification criteria, 27 did not meet reclassification criteria and 13 had insufficient data. Of the 27 patients that did not meet criteria, 12 patients did not meet the lab criteria (44.4%), five patients did not meet the clinical criteria (18.5%) and 10 patients did not meet both laboratory and clinical criteria (37%). Of the 11 patients that met reclassification criteria, one patient was triple positive (9%), three patients were double positive (27.2%), and seven patients were single positive (63.6%).    Conclusions: Results from this study indicate that APS continues to be a complex disease state with challenges in diagnosis and classification. Since only a small number of patients at our institution continued to meet the updated classification criteria for APS, opportunities for patient re-evaluation at other institutions should be considered. Based on the outcomes of this study, future directions include updating laboratory results to aid in interpretation and offering provider education series on the new APS classification criteria.   

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