Antiphospholipid syndrome

Antiphospholipid syndrome

1. Cause

   • autoimmune
     • ?antiphospholipid antibodies
       • lupus anticoagulant
       • anti-cardiolipin
       • anti-β2-glycoprotein-I
     • complement and platelet activation
   • genetic
   • unknown

2. presentation

   • hypercoagulable state
     • venous
       • DVT
       • PE
     • arterial
       • stroke
   • pregnancy complications
     • stillbirth
     • miscarriage
     • preterm delivery
     • severe pre-eclampsia
   • Livedo reticularis
   • haemolytic anaemia
   • thrombocytopenia

3. Types

   • Primary
     • HLA-DR7
   • Secondary
     • risk factors
       • associated with other autoimmune diseases e.g. SLE, RA
       • HLA-B8, HLA-DR2, HLA-DR3
       • ethnicity
       • most common in young fertile women

4. Management

   • Lifestyle to reduce cardiovascular risks
   • Thrombosis risk
     • Acute
       • Heparin
     • Long term
       • Warfarin (INR 2-3) or antiplatelet
   • In pregnancy
     • LMWH + aspirin

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