Comment on: Loss of antiphospholipid antibody positivity decreases the risk of recurrent thrombosis in thrombotic antiphospholipid syndrome

Dear Editor, We read with great interest the article by Gaspar et al. [1] demonstrating that sustained loss of antiphospholipid antibody (aPL) positivity was associated with a marked reduction in the risk of recurrent thrombosis in patients with thrombotic antiphospholipid syndrome (APS). This important study provides robust evidence supporting the prognostic value of longitudinal aPL monitoring in APS and reinforces the concept that persistent aPL positivity identifies patients at the highest thrombotic risk. Transient aPL positivity, reported in ∼9–32% of patients with APS across different clinical phenotypes and follow-up durations, is more frequently observed in asymptomatic individuals and in those with isolated or low-titre antibodies. Available longitudinal data indicated that aPL negativization was associated with a markedly reduced risk of thrombotic recurrence compared with persistent aPL positivity, particularly when high titers or triple positivity are absent [2]. While these data strongly support the clinical relevance of aPL persistence for thrombotic risk stratification, the vascular consequences of transient aPL exposure remain largely unexplored, particularly with respect to endothelial dysfunction.