Antiphospholipid Syndrome

Question 1

What is APS?

Answer 1

Disorder associated with antiphospholipid antibodies where blood becomes prone to clotting

-Can be primary or secondary

Question 2

What are the symptoms?

Answer 2

VTE

• DVT= red, hot, swollen leg
• PE= SoB, chest pain, cough/coughing up blood

Arterial thrombosis

• less common
• stroke
• MI
• Renal thrombosis

Pregnancy complications

• recurrent miscarriage
• stillbirth
• PET

Livedo reticularis
-purple lace like rash

Libmann Sacks endocarditis

• non bacterial endocarditis
• growths of valves on heart

Thrombocytopenia
Migraines
Epilepsy

Question 3

What are the investigations?

Answer 3

ESR-normal
ANA-negative
APTT- increased (thrombosis risk still high)

Coombs test positive

Anticardiolipin antibodies- diagnostic

Lupus anticoagulant antibodies

• present in 20%
• increased risk of thrombosis

Question 4

How is it diagnosed?

Answer 4

2 high anticardiolipin antibodies on 2 separate titres 12 weeks apart

History of thrombosis or pregnancy complications

Question 5

What is the management?

Answer 5

MDT involvement
Long term warfarin
-INR target 2-3 to prevent thrombosis
-INR target 3-4 if recurrent thrombosis

LMWH
-if pregnant plus aspirin to reduce risk of complications

No thrombotic history

• low dose aspirin
• lifestyle advice- do not sit still for long periods of time

Long term prognosis poor with 1/3 having organ damage within 10 years