#3-90E. Rethinking Lifelong Anticoagulation: The Impact of aPL Negativization in APS (Rheumatology, 2025)

Should patients with thrombotic antiphospholipid syndrome (APS) remain on lifelong antithrombotic therapy even if their antibody profiles change? This episode reviews a retrospective cohort study of 116 adult patients with thrombotic APS, evaluating the predictive value of antiphospholipid antibody (aPL) negativization on recurrent thrombosis. Over a median follow-up of 99 months, approximately 32% of patients achieved persistent aPL-negativization. The most pivotal clinical finding is that the cumulative incidence of recurrent thrombosis dropped significantly by 88% after patients became aPL-negative. However, when critically appraising this evidence, clinicians must consider the study's single-center retrospective design and the lack of a standardized institutional protocol for the timing of aPL retesting, which could introduce variability. Despite these limitations, this paper is highly relevant for practicing physicians because it highlights the clinical utility of serial aPL monitoring. Tracking these serological changes allows doctors to identify a low-risk subset of patients with a favorable long-term prognosis, which could ultimately guide individualized, de-escalated antithrombotic strategies and improve patient management.

Citation: Gaspar P , Graça L, Fonseca JE, et al. Loss of antiphospholipid antibody positivity decreases the risk of recurrent thrombosis in thrombotic antiphospholipid syndrome. Rheumatology. 2025. DOI: 10.1093/rheumatology/keaf679

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