Thrombocytopenia in carriers and patients with antiphospholipid syndrome: insights from the nationwide START-APS registry

Abstract Patients with thrombotic antiphospholipid syndrome (APS) or subjects with persistent presence of antiphospholipid antibodies (aPLA), defined “carriers”, may develop thrombocytopenia. However, the prevalence and clinical characteristics associated with thrombocytopenia remain poorly understood. We aimed to describe the prevalence and the clinical characteristics associated with thrombocytopenia in APS patients and aPLA carriers included in the Survey on AnTicoAgulated Patients-RegisTry on antiphospholipid antibodies (START-APS), a multicentre prospective registry. Thrombocytopenia was defined as a platelet count < 150 × 10 9 /L, while moderate-to-severe form was defined as < 100 × 10 9 /L. Logistic regression analysis was performed, and results were expressed as Odds Ratio (OR) and 95% confidence interval (95%CI). A total of 464 patients were included (148 aPLA carriers, 316 APS), mean age was 57.3 ± 15.6 years, and 66.5% were women. 63 (13.6%) patients presented with thrombocytopenia; 15.2% in APS patients and 10.1% in aPLA carriers ( p = 0.138). Overall, triple positive pattern (OR 1.90, p = 0.002), livedo reticularis (OR 3.57, p = 0.029), heart failure (OR 4.52, p = 0.039), and female sex (OR 0.59, p = 0.011) were associated with thrombocytopenia. Triple positivity (OR 5.44, p < 0.001) and history of myocardial infarction (OR 6.52, p = 0.009) were associated with moderate-to-severe thrombocytopenia. Thrombocytopenia may occur early also in aPLA carriers, raising to 15% in APS patients, especially in those presenting with triple positivity and cardiovascular involvement. This association was confirmed also with moderate-to-severe thrombocytopenia.

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Publication Details

Journal
Internal and Emergency Medicine
Published
2026-06-16
DOI
https://doi.org/10.1007/s11739-026-04416-9
Primary Topic
Systemic Lupus Erythematosus Research
Type
article
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article

Thrombocytopenia in carriers and patients with antiphospholipid syndrome: insights from the nationwide START-APS registry

Paolo Gresele, Laura Banov, Corrado Lodigiani, Pasquale Pignatelli et al.
Internal and Emergency Medicine
Systemic Lupus Erythematosus Research
article

Thrombocytopenia in carriers and patients with antiphospholipid syndrome: insights from the nationwide START-APS registry

Paolo Gresele, Laura Banov, Corrado Lodigiani, Pasquale Pignatelli, Alberto Maino, Bianca Clerici, Vittorio Pengo, Erica De Candia, Paul R. J. Ames, Carmine Spataro, Luca Barcella, Jacopo Agnelli Giacchello, Tommaso Bucci, Simona Pedrini, Antonella Tufano, Silvia Bozzato, Giuseppe Vercillo, Luca Puccetti, Anna Falanga, Beniamino Zalunardo, Raffaella Benedetti, Alberto Tosetto, Chiara Ambaglio, Vittorio Fregoni, Piera Sivera, Gian Marco Podda, Vincenzo Oriana, Elisa Bison, Maria Canfora, Emilia Antonucci, Francesca Schieppati, Elena Lotti, Luca Sarti, Elena Silvestri, Rossella Morandini, Oriana Paoletti, Giuseppe Carli, Laura Contino, Gessica Marchesini, Verusca Brusegan, Michela Frulla, Francesco Del Sole, Andrea Toma, Alice Lipari, Eugenio Bucherini, Anna Aiello, Roberto Santi, Doris Barcellona, Attilia Maria Pizzini, Ariela Hoxha, Sophie Testa, Marina Marchetti, Daniela Poli, Sara Gamba, Pancani Roberta, Domenico Prisco, Vercillo Giuseppe, Danilo Menichelli, Adriana Visonà, START-A. P. S. Investigators^, Giovanna Colombo, Maria Sophia Cotelli, Davide Imberti, Nello Zanatta, Antonio Chistolini, Daniele Pastori
article en

Abstract

Abstract Patients with thrombotic antiphospholipid syndrome (APS) or subjects with persistent presence of antiphospholipid antibodies (aPLA), defined “carriers”, may develop thrombocytopenia. However, the prevalence and clinical characteristics associated with thrombocytopenia remain poorly understood. We aimed to describe the prevalence and the clinical characteristics associated with thrombocytopenia in APS patients and aPLA carriers included in the Survey on AnTicoAgulated Patients-RegisTry on antiphospholipid antibodies (START-APS), a multicentre prospective registry. Thrombocytopenia was defined as a platelet count < 150 × 10 9 /L, while moderate-to-severe form was defined as < 100 × 10 9 /L. Logistic regression analysis was performed, and results were expressed as Odds Ratio (OR) and 95% confidence interval (95%CI). A total of 464 patients were included (148 aPLA carriers, 316 APS), mean age was 57.3 ± 15.6 years, and 66.5% were women. 63 (13.6%) patients presented with thrombocytopenia; 15.2% in APS patients and 10.1% in aPLA carriers ( p = 0.138). Overall, triple positive pattern (OR 1.90, p = 0.002), livedo reticularis (OR 3.57, p = 0.029), heart failure (OR 4.52, p = 0.039), and female sex (OR 0.59, p = 0.011) were associated with thrombocytopenia. Triple positivity (OR 5.44, p < 0.001) and history of myocardial infarction (OR 6.52, p = 0.009) were associated with moderate-to-severe thrombocytopenia. Thrombocytopenia may occur early also in aPLA carriers, raising to 15% in APS patients, especially in those presenting with triple positivity and cardiovascular involvement. This association was confirmed also with moderate-to-severe thrombocytopenia.

Internal and Emergency Medicine
University of Padua (IT), University of Liverpool (GB), University of Cagliari (IT), University of Perugia (IT), Dumfries and Galloway Royal Infirmary (GB), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT), Istituto Neurologico Mediterraneo (IT), Liverpool Heart and Chest Hospital (GB), Ospedale Maggiore (IT), Nova Medical (United States) (US), Azienda Ospedaliero-Universitaria Careggi (IT), A. O. Ordine Mauriziano di Torino (IT), National Cancer Institute (MY), Universidade Nova de Lisboa (PT), Sapienza University of Rome (IT)
Good health and well-being
Openalex Percentile: Top 7%
Systemic Lupus Erythematosus Research
DOIOpen Access PDFOpenAlex
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