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Antiphospholipid Antibody Syndrome
Aka: Antiphospholipid Antibody Syndrome, Antiphospholipid Syndrome, Lupus Anticoagulant Disorder
- Pathophysiology
- Recurrent thrombosis of any size vessel
- May have no link with SLE despite early associations
- Diagnosis
- Major clinical associations
- Venous thrombosis
- Deep Vein Thrombosis
- Pulmonary Embolism
- Arterial thrombosis
- Cerebrovascular Accident (CVA)
- Transient Ischemic Attacks
- Myocardial Infarction
- Gangrene
- Recurrent Pregnancy Loss
- Thrombocytopenia
- Hemolytic Anemia
- Other clinical associations
- Heart Valve abnormality
- Positive Coombs tests
- Livedo reticularis
- Migraine Headaches
- Leg ulcers
- Myelopathy
- Chorea
- Pulmonary Hypertension
- Avascular necrosis
- Lab tests
- Autoantibodies are present in 5% of healthy patients
- Positive anticardiolipin test (most sensitive test)
- IgG > 20 GPL
- IgM > 20 MPL units
- Possibly IgA positive
- Positive Lupus Anticoagulant (most specific test)
- Anti-B2-Glycoprotein I Autoantibodies
- False PositiveVDRL (30-40%)
- Prevention of thrombotic complications
- Anticoagulation
- Coumadin
- Moderate to high dose (INR >2) is protective
- Low dose (INR <1.9) does not prevent thrombosis
- Aspirin
- Protects against pregnancy loss
- Does not protect against thrombosis
- Avoid factors predisposing to thrombosis
- Oral Contraceptive use
- Immobility
- Modify atherosclerotic risk factors
- Hyperlipidemia
- Tobacco Abuse
- Diabetes Mellitus
- References
- Levine (2002) N Engl J Med 346:752-63 [PubMed]