350 - Antiphospholipid Syndrome

Question 1

What are the common characteristics of APS? (2)

Answer 1

thrombosis (arterial/venous)

pregnancy complications

Question 2

When will APS be considered secondary?

Answer 2

when appear with other AI disease (SLE…)

Question 3

Define catastrophic APS:

Answer 3

rapidly progressive life-threatening thromboembolic disease which involves >= 3 organs

Question 4

APS is a syndrome of ___ (thrombophilia), mediated by ___

Answer 4

hypercoagulability

auto Ab

Question 5

Which disease may be false positively diagnosed together with APS?

Answer 5

syphilis

Question 6

To diagnose APS we need 1 ___ sign and 1 ___ sign together with the absent of other reasons for a hypercoagulability state

Answer 6

clinical

lab

Question 7

Name two clinical signs for APS

Answer 7

Thrombosis (venous/arterial)

Obstetric problem

Question 8

What kind of obstetric problems are relevant for APS diagnosis? (3)

Answer 8

death of a healthy embryo within the first 10 weeks
severe preeclampsia leading to early birth
>=3 abortions (<10 weeks)

Question 9

List 3 lab characteristics for APS diagnosis

Answer 9

lupus anticoagulant
anticardiolipin
anti beta2GPI

Question 10

DVT (__%) occurs mainly in the lower limbs leading to PE (__%), livedo reticularis (__%)

Answer 10

39
15
24

Question 11

Thrombosis in the ____ leads to pulmonary hypertension and thrombosis of the inferior vena cava and to ___ syndrome

Answer 11

pulmonary arteries

Budd-Chiari

Question 12

What are the 4 most common arterial thrombi in APS?___(20%), ___(14%), ___(11%), ___(10%)

Answer 12

stroke
Liebman Sacks (cardiac valve injury)
TIA
MI

Question 13

The most common neurological symptom of APS is __ (20%)

Answer 13

migraine

Question 14

The most common hematological signs of APS are__ (30%) and ___ (10%)

Answer 14

thrombocytopenia

AIHA

Question 15

Treating APS after the first episode requires life long treatment of ____. INR should be kept between __-__. This could be the sole therapy or in combination with ___

Answer 15

warfarin (Coumadin)
2.5-3.5
aspirin

Question 16

If APS patients suffer from recurrent thromboembolic events with optimal therapy- treat with ___ (400 mg/kg per day) for ___ days

Answer 16

IVIg

5

Question 17

APS patients during pregnancy should be treated with ____ + ____

Answer 17

LMWH ( clexane)

aspirin

Question 18

If the APS patient develops HIT under treatment- give factor X inhibitors (___) or ___

Answer 18

fondaparinux
rivaroxaban (Xarelto)