A Practical Guide to Haemostasis

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


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:

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


[Max score 17 points]

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.

7.0 .38 .61
9.0 .40 .62
13.0 .56 .74

NPV - Negative Predictive Value; PPV - Positive Predictive Value

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