Antiphospholipid syndrome Flashcards
Definition
Disorder associated with antiphospholipid antibodies where the blood becomes prone to clotting. The patient is in a hyper-coagulable state.
The main associations are with thrombosis and complications in pregnancy, particularly recurrent miscarriage.
Risk factors
Diabetes
HTN
Obesity
Female
Underlying systemic autoimmune condition
Smoking
Oestrogen therapy for menopause
Aetiology
Antiphospholipid syndrome can occur on its own or secondary to an autoimmune condition, particularly systemic lupus erythematosus.
It is associated with antiphospholipid antibodies:
- Lupus anticoagulant
- Anticardiolipin antibodies
- Anti-beta-2 glycoprotein I antibodies
These antibodies interfere with coagulation and create a hypercoagulable state where the blood is more prone to clotting.
Signs
- Arterial Thrombosis
= Stroke
= Myocardial infarction
= Renal thrombosis - Recurrent miscarriages/ Stillbirths/ Preeclampsia
- Livedo reticularis is a purple lace like rash that gives a mottled appearance to the skin.
- Libmann-Sacks endocarditis is a type of non-bacterial endocarditis where there are growths (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.
Diagnosis
History of thrombosis or pregnancy complication plus persistent antibodies:
Lupus anticoagulant
Anticardiolipin antibodies
Anti-beta-2 glycoprotein I antibodies
Management
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 are started on low molecular weight heparin (e.g. enoxaparin) plus aspirin to reduce the risk of pregnancy complications. Warfarin is contraindicated in pregnancy.
Complications
DVT
P.E
Stroke
MI
Renal thrombosis
Pregnancy complications
