Antiphospholipid Antibody Syndrome

Question 1

What is antiphospholipid antibody syndrome?

Answer 1

APS is an autoimmune disorder defined by the presence of characteristic clinical features and specified levels of circulating antiphospholipid antibodies

Question 2

How is antiphospholipid syndrome diagnosed?

Answer 2

Clinical and laboratory criteria. Labs have to be persistently positive 12 weeks apart.

Question 3

What are the clinical criteria for diagnosis of APS?

Answer 3

1:
Vascular thrombosis

2:

• One or more SAB after 10 weeks
• Three or more SAB before 10 weeks
• Pregnancy complicated with placental insufficiency, eclampsia/severe preeclampsia before 34 weeks

Question 4

What are the laboratory criteria for diagnosis of APS?

Answer 4

• Lupus anticoagulant
• Beta 2 glycoprotein IgM, IgG (titer greater than 99th percentile for a normal population)
• Anticardiolipin antibody IgM, IgG (greater than 40 GPL or MPL, or greater than the 99th percentile)

***on 2 occasion greater than 12 weeks apart

Question 5

How do you counsel a patient about the diagnosis of antiphospholipid antibody syndrome in pregnancy ?

Answer 5

• pregnancy loss
• preeclampsia
• growth restriction
• venous thrombosis and arterial thrombosis (most common)
• autoimmune thrombocytopenia occurs in 40–50%
• autoimmune hemolytic anemia

RARE

• livedo reticularis, cutaneous ulcers, chorea gravidarum, multi-infarct dementia, and transverse myelitis
• catastrophic APS occurs in some individuals who develop progressive thromboses and multiorgan failure

Question 6

How do you manage pregnancy in a patient with APS?

Answer 6

• Detailed anatomic survey
• Fetal growth
• Lovenox
• Aspirin

Question 7

What are the risks of APS to a pregnancy?

Answer 7

• Recurrent pregnancy loss
• Preeclampsia
• IUGR
• Stillbirth
• Vascular thrombosis

Question 8

What anticoagulation regimen do you recommend for pregnant patients with APS syndrome?

Answer 8

LMWH - 40mg daily

Aspirin - 81mg daily

Question 9

How do you manage anticoagulation near term in patient with APS syndrome?

Answer 9

Discontinue 12 hours to scheduled delivery, SCDs while intrapartum, resume 6-12 hours post delivery (6 hours after vaginal and 12 hours after c-section)

Question 10

How long do you continue anticoagulation for APS in the postpartum period?

Answer 10

6 weeks

Question 11

Long term risks of antiphospholipid syndrome?

Answer 11

• thrombosis
• SLE

referral to rheumatologist or hematologist postpartum