Antiphospholipid Antibody Syndrome

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Thursday, September 1, 2005

PTINR.com Staff

Not all patients are at equal risk of thrombosis increasing the difficulty in determining the most safe, effective treatment path.

Antiphospholipid Syndrome (APS) is a relatively rare disorder requiring anticoagulation for patients diagnosed with it. CHEST, 2004 recommends patients with no additional underlying medical condition are placed on warfarin (Coumadin ®) with a INR target of 2.5 (range 2.0-3.0). Patients however with recurrent thromboembolic events benefit from a higher target of INR = 3.0 (range 2.5-3.5) Grade 2B, 2C respectively.

The antiphospholipid syndrome is a disorder of the immune system that is characterized by excessive clotting of blood and/or certain complications of pregnancy (premature miscarriages, unexplained fetal death, or premature birth) and antiphospholipid antibodies (cardiolipin or lupus anticoagulant antibodies). Patients with antiphospholipid syndrome have developed abnormal symptoms while having antiphospholipid antibodies detectable in the blood. medicinenet.com

Antiphospholipid syndrome can sometimes be referred to as AS, APS, AAS, or Hughes syndrome for the doctor who first discovered it.

It is important to note that antiphospholipid antibodies can also be found in the blood of individuals without any disease process. In fact, antiphospholipid antibodies have been reported in approximately 2 percent of the normal population. Harmless antiphospholipid antibodies can be detected in the blood for a brief period occasionally in association with a wide variety of conditions, including bacterial, viral (hepatitis, HIV), and parasite (malaria) infections. Certain drugs can cause antiphospholipid antibodies to be produced in the blood, including antibiotics, cocaine, hydralazine, procainamide , and quinine.

Nevertheless, the antiphospholipid antibody (a protein) is not considered a normal blood protein and has been found in patients to be associated with a number of illnesses. These illnesses include abnormal clotting (thrombosis) of arteries (stroke, infarction) and/or veins (phlebitis), premature miscarriages (spontaneous abortions), abnormally low blood platelet counts (thrombocytopenia), purplish mottling discoloration of the skin (livedo reticularis), migraine headaches, and a rare form of inflammation of the nervous tissue of the brain or spinal cord, called transverse myelitis. Antiphospholipid antibodies have also been detected in over half of patients with the immune disease systemic lupus erythematosus. medicinenet.com

The measurement of monitoring oral anticoagulation is more involved than non-APS anticoagulation use including measurement of: prothrombin activity, native prothrombin concentration, and the prothrombin and proconvertin test.

Not all patients with the presence of phospholipids antibodies are at equal risk of thrombosis increasing the difficulty of determining the most safe, effective treatment path.

The neuroland.com website recommends patients with APS to reduce their risk of thrombosis by:

•  avoiding oral contraceptives

•  maintaining ideal weight, cholesterol levels & activity

•  control blood pressure

•  avoid smoking

APS patients experiencing a previous clotting event are more aggressively treated with warfarin and are slightly more at risk of bleeding. Patients are encouraged to visit our tools section for helpful tips on how to stay safe at home and during travel.

Patients are also encouraged to use the “search” button to find resources to prevent injury from falls. An August 1 st search found 14 matches to references related to fall prevention.