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A Practical Guide to Haemostasis


Estimating the Risk of Thrombosis in the Antiphospholipid Syndrome:
The Adjusted Global Anti-Phospholipid Syndrome Score [aGAPSS]

Introduction:

The Global Anti-Phospholipid Syndrome score [GAPSS] was developed to identify individuals with APS at greater risk of thrombosis and/or pregnancy loss and is derived from a combination of conventional cardiovascular risk factors and the autoimmune antibody profile - including both criteria and non-criteria aPL antibodies - see Comments. 

In the Adjusted Global Anti-Phospholipid Syndrome Score [aGAPSS], aPS/PT antibodies are excluded from the scoring algorithm recognising that these antibodies are not currently included in the criteria for defining APS and not all laboratories routinely test for aPS-PT antibodies. 

In the GAPSS algorithm, six variables:
  - Arterial hypertension
  - Hyperlipidaemia
  - aCL antibodies
  - LA
  - Anti-β2GPI antibodies
  - aPS/PT [antibodies to solid-phase Prothrombin (aPT) and to the phosphatidylserineprothrombin complex (aPS/PT)
..... were shown to be independent risk actors for thrombosis and pregnancy loss after multivariate analysis.


The aGAPSS Score:


The criteria that comprise the Adjusted GAPSS [aGAPSS] score are summarised below:


Select Criteria:

Hyperlipidaemia
3 Points
Arterial Hypertension
1 Point
aCL IgG/IgM antibodies
5 Points
Anti-β2GPI IgG/IgM antibodies
4 Points
Lupus Anticoagulant [LA]
4 Points


Score

[Max score 17 points]



Comments:
For further information on this algorithm and the interpretation of results - see Ref 2.  Overall, a significantly higher aGAPSS was found in patients with recurrent thrombosis (arterial or venous) compared to those without recurrence.


aGPASS Score PPV NPV
7.0 .38 .61
9.0 .40 .62
13.0 .56 .74


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