Antiphospholipid syndrome

Question 1

What is antiphospholipid syndrome?

Answer 1

A disorder associated with antiphospholipid antibodies which create hyper-coagulable state
- causing increased thrombosis risk and risk of miscarriage

Can occur on its own or secondary to an autoimmune condition esp. SLE

Question 2

What are the phospholipid antibodies?

Answer 2

Lupus anticoagulant
Anticardiolipin antibodies
Anti-beta-2 glycoprotein I antibodies

These interfere with coagulation

Question 3

What is antiphospholipid syndrome associated with?

Answer 3

VTE - DVT, PE

Arterial thrombosis:

• Stroke
• MI
• Renal thrombosis

Pregnancy complications:

• Recurrent miscarriage
• Stillbirth
• Pre-eclampsia

Question 4

What are some other features seen in Antiphospholipid syndrome?

Answer 4

Livedo reticularis - purple lace like rash that gives a mottled appearance to the skin.

Libmann-Sacks endocarditis is a type of non-bacterial endocarditis involving vegetations on the valves of the heart.

• The mitral valve is most commonly affected.
• It is associated with SLE and antiphospholipid syndrome.

Thrombocytopenia (low platelets) is common in antiphospholipid syndrome.

Question 5

Diagnosis of antiphospholipid syndrome

Answer 5

History of thrombosis/ pregnancy complications plus persistent antibodies present

Question 6

Management of antiphospholipid syndrome

Answer 6

Long term warfarin with an INR range of 2-3 is used to prevent thrombosis (3-4 may be used with recurrent thrombosis).

Pregnant women started on LMWH plus aspirin to reduce risk of pregnancy complications
- Warfarin CI in pregnancy