Antiphospholipid Syndrome

Question 1

What is antiphospholipid syndrome?

Answer 1

• This is a disorder associated with antiphospholipid antibodies where the blood becomes prone to clotting.
• The patient is in a hypercoagulable state.
• It can be a primary condition or secondary to other conditions such as SLE.

Question 2

what are the 3 associated autoantibodies ?

Answer 2

1) Lupus anticoagulant
2) Anticardiolipin antibodies
3) Anti-beta-2 glycoprotein I antibodies

Question 3

what are the associated complications of antiphospholipid syndrome? (6)

Answer 3

1) VTE – Deep vein thrombosis, PE
2) Arterial thrombosis – stroke, MI, renal thrombosis
3) Pregnancy complications – recurrent miscarriage, stillbirth, preeclampsia
4) Livedo reticularis - purple rash that gives a mottled appearance to skin
5) Libmann-Sacks endocarditis – non-bacterial endocarditis where there are vegetations on the valves of the heart, most commonly mitral valve.
6) Thrombocytopaenia – common.

Question 4

how do you diagnose antiphospholipid syndrome?

Answer 4

1) History of thrombosis or pregnancy complications

2) Persistent antibodies mentioned as above

Question 5

how is antiphospholipid syndrome managed?

Answer 5

1) Managed between rheum, haem and obstetrics.
2) Long term warfarin with target INR of 2-3 to prevent thrombosis and if recurrent target INR 3-4.
3) Pregnant women started on LMWH + aspirin to reduce risk of complications as warfarin contraindicated in pregnancy.