Antiphospholipid syndrome (Complete) Flashcards
What is antiphospholipid syndrome?
Syndrome characterised by venous and arterial clot formation, adverse pregnancy outcomes and raised antiphospholipid antibodies.
Antiphospholipid syndrome can occur as a primary condition but is often secondary to what condition?
Systemic lupus erythematosus
Antiphospholipid syndrome is associated with what other causes?
Autoimmune disorders (e.g. SLE)
Lymphoproliferative disorders
Phenothiazines (anti-psychotic meds) [rare]
What are the main features of antiphospholipid syndrome?
Mnemonic: CLOT
C: Clots (usually venous thromboembolism but can cause arterial)
L: Livedo reticularis
O: Obsteric loss
T: Thrombocytopenia
Cardiac valve disease: Aortic and mitral regurgitation +/- stenosis
How does clot formation typically present in patients with antiphospholipid syndrome?
Venous thromboembolism: DVT and PE
Arterial thromboembolism: MI, stroke
What is livedo reticularis?
A mottled, lace-like appearance of the skin on the lower limbs
What obsteric complications are associated with anti-phospholipid syndrome?
Recurrent miscarriages
Pre-eclampsia
Premature births
What investigations are used in diagnosis of anti-phospholipid syndrome?
Bloods:
FBC: Check for thrombocytopenia
Anti-cardiolipin antibodies: Positive
Anti-beta2-GPI antibodies: Positive
Lupus anticoagulant assay: Positive
Treponemal serology: Rule out syphillis
Why is it important to rule out syphillis when investigating for anti-phospholipid syndrome?
Can cause false positive for diagnostic blood tests
What criteria must be met to diagnose anti-phospholipid syndrome?
One or more of the following positive blood tests are needed on 2 occasions, 12-weeks apart to diagnose APS:
Anti-cardiolipin antibodies
Anti-beta2-GPI antibodies
Positive lupus anticoagulant assay
What is the management plan for patients diagnosed with antiphospholipid syndrome?
Conservative:
Venous thromboembolism: Avoid OCP, HRT and long periods of immobility
Arterial thromboembolism: Exercise, smoking, manage BP, glucose, lipids
Medicine:
Venous thrombotic event: Lifelong warfarin with target INR 2-3
Reccurent venous events: Lifelong warfrain with target INR 3-4
Arterial thrombotic event: Lifelong warfarin with target INR 2-3
In patients diagnosed with antiphospholipid syndrome with no thromboembolic event. What management is reccomened?
Conservative measures only, focusing on reducing risk factors
What is target INR for antiphospholipid patients who’ve had an arterial or venous thrombotic event?
2-3
What is target INR for antiphospholipid patients who’ve had recurrent venous thrombotic events?
INR 3-4
What should be given instead of warfarin in pregnant patients?
Low-molecular weight heparin (LMWH)
N.B. Warfarin is teratogenic
