Antiphospholipid antibody

First episode of VTE with documented antiphospholipid antibodies or two or more hypercoagulable abnormalities Warfarin 24+ Continue warfarin therapy after 24 months if patient is at low risk for bleeding... 

Tests for hypercoagulable states, such as protein C deficiency and antiphospholipid antibody, should be done only when the cause of stroke cannot be determined based on the presence of well-known risk factors for stroke. 

Antiphospholipid antibodies include lupus anticoagulants (LAs) and anticardi-olipin (aCL) antibodies. Lupus anticoagulants are immunoglobulins that are characterized by their ability to inhibit phospholipid-dependent coagulation assays. In contrast, aCL antibodies are measured in an enzyme-linked immunosorbent assay... 

Galli M Finazzi G Barbui T. Antiphospholipid antibodies Predictive value of laboratory tests. Thromb Haemost 1997 78,75-8. 

Esmon N. L., Smirnov M. D., Esmon C. T. Thrombogenic mechanisms of antiphospholipid antibodies. Thromb Haemost 1997 78,79-82. 

Bizzaro N., Brandalise M. EDTA-dependent pseudothrombocytopenia. Association with antiplatelet and antiphospholipid antibodies. Am J Clin Pathol 1995 103, 103-7. 

Laboratory tests for hypercoagulable states should be done only when the cause of the stroke cannot be determined based on the presence of well-known risk factors. Protein C, protein S, and antithrombin III are best measured in steady state rather than in the acute stage. Antiphospholipid antibodies are of higher yield but should be reserved for patients aged less than 50 years and those who have had multiple venous or arterial thrombotic events or livedo reticularis. 

Hypercoagulable states include malignancy activated protein C resistance deficiency of protein C, protein S, or antithrombin factor VIII or XI excess antiphospholipid antibodies and other situations. Estrogens and selective estrogen receptor modulators have been linked to venous thrombosis, perhaps due in part to increased serum clotting factor concentrations. Although a thrombus can form in any part of the venous circulation, the majority of thrombi begin in the lower extremities. Once formed, a venous... 

Patients with an idiopathic VTE, an inherited disorder of hypercoagula- IA bilily, or antiphospholipid antibodies should be treated indefinitely (at least 2.5 years)... 

CHCs should be avoided in women with SLE and antiphospholipid antibodies or vascular complications. Progestin-only contraceptives can be... 

In selected circumstances and secondary headache presentation, serum chemistries, urine toxicology profiles, thyroid function tests, lyme studies, and other blood tests, such as a complete blood count, antinuclear antibody titer, erythrocyte sedimentation rate, and antiphospholipid antibody titer may be considered. 

Yamazaki (Y2) detected increased Lp(a) and PA1 activity in patients with the antiphospholipid antibody syndrome with arterial thrombosis. 

M18. Matsuda, J., Gotoh, M., Gohchi, K., Saitoh, N., and Tsukamoto, M.. Serum lipoprotein(a) level is increased in patients with systemic lupus erythematosus irrespective of positivity of antiphospholipid antibodies. Thromb. Res. 73, 83-84 (1994). 

Y2. Yamazaki, M., Asakura, H., Jokaji, H., Saito, M., Uotani, C., Kumabahiri, I., Morishita, E., Aoshima, K., Ikeda, T., and Marsuda, T., Plasma levels of lipoprotein(a) are elevated in patients with the antiphospholipid antibody syndrome. Thromb. Haemostasis 71, 424-427 (1994). 

The increased risk of thromboembolism associated with atrial fibrillation and with the placement of mechanical heart valves has long been recognized. Similarly, prolonged bed rest, high-risk surgical procedures, and the presence of cancer are clearly associated with an increased incidence of deep venous thrombosis and embolism. Antiphospholipid antibody syndrome is another important acquired risk factor. Drugs may function as synergistic risk factors in concert with inherited risk factors. 

Asherson RA, Harris NE, Gharavi AE, Hughes GR. Systemic lupus erythematosus, antiphospholipid antibodies, chorea, and oral contraceptives. Arthritis Rheum 1986 29(12) 1535-6. 

Lopez-Pedrera, C., Buendia, P., Cuadrado, MJ., Siendones, E., Aguirre, M.A., Barbarroja, N., Montiel-Duarte, C., Torres, A., Khamashta, M., and F. Velasco, 2006, Antiphospholipid antibodies from patients with the antiphospholipid syndrome induce monocyte tissue factor expression through the simultaneous activation of NF-kappaB/Rel proteins via the p38 mitogen-activated protein kinase pathway, and of the MEK-l/ERK pathway.Arthritis Rheum. 54(1) 301—11. 

Rand, J.H., Wu, X.X., Quinn, A.S., Chen, P.P., McCrae, K.R., Bovill, E.G., and D.J.Taatjes, 2003, Human monoclonal antiphospholipid antibodies disrupt the annexin A5 anticoagulant crystal shield on phospholipid bilayers evidence from atomic force microscopy and functional assay. Am J Pathol. 163(3) 1193-200. 

Yasuda, S., Bohgaki, M., Atsumi, T., and T. Koike, 2005, Pathogenesis of antiphospholipid antibodies impairment of fibrinolysis and monocyte activation via die p38 mitogen-activated protein kinase pathway.Immunobiology. 210(10) 775-80. 

I 84 Asherson FLA, Antiphospholipid antibodies. Clinical complications reported in medical literature, In Harris EN, Exner T, Hughes GRY Asherson FLA, eds, Phospholipid-Binding Antibodies. Boston CRC Press, Inc, 1991 388-402,... 

Antiphospholipid syndrome is a disorder of recurrent arterial or venous thrombosis, thrombocytopenia, hemolytic anemia, or a positive Coombs test, and in women recurrent idiopathic fetal loss, associated with raised concentrations of antiphospholipid antibodies. In systemic lupus erythematosus, the risk of this syndrome is about 40%, compared with a risk of 15% in the absence of antiphospholipid antibodies (539). However, only half of those with antiphospholipid antibodies have systemic lupus erythematosus, and the overall risk of the syndrome is about 30%. In patients who have antiphospholipid antibodies associated with chlorpromazine, there appears to be no increased risk of the syndrome. In contrast, in the primary antiphospholipid syndrome, the only clinical manifestations are the features of this syndrome. 

McNeil HP, Chesterman CN, Krilis SA. Immunology and clinical importance of antiphospholipid antibodies. Adv Immunol 1991 49 193-280. 

Small, friable and sterile vegetations made of fibrin and platelets can be found on the heart valves of patients with cancer, in the antiphospholipid antibody syndrome systemic lupus erythematosus and possibly in protein C deficiency. Thrombotic emboli from such vegetations can be demonstrated using trans-esophageal echocardiography and are frequently seen in patients with cancer and cerebral ischemia (Dutta et al. 2006b). 

Giant cell arteritis Systematic lupus erythematosus Antiphospholipid antibody syndrome... 

Sometimes arterial occlusion is demonstrated by angiography in migrainous stroke and the cause is hypothesized to be in-situ thrombosis complicating vasospasm. No provoking factors are known. Other possible causes of stroke in the context of headache must be considered carotid dissection, mitochondrial cytopathy, ruptured vascular malformation, antiphospholipid antibody syndrome and CADASIL (cerebral autosomal dominant arterio-pathy with subcortical infarcts and leukoencephalopathy). Migraine auras without headache may be confused with TIA (Ch. 8). 

Lhermitte F, Gautier JC, Derouesne C (1970). Nature of occlusions of the middle cerebral artery. Neurology 20 82-88 Liang P and Hoffmann GS (2005). Advances in the medical and surgical treatment of Takayasu arteritis. Current Opinions in Rheumatology 17 16-24 Lim W, Crowther MA, Eikelboom JW (2006). Management of antiphospholipid antibody syndrome a systematic review. Journal of the American Medical Association 295 1050-1057... 

DeGroot PG, Derksen RH (2004) Antiphospholipid antibodies update on detection, pathophysiology and treatment. Curr Opin Hematol 11 165-169. 

Sauna G, Bertolaccini ML, Cuadi ado MJ Laing H, Kliamashta MA, Matliieu A, Huglies GR (2003b) Neuropsychiatiic manifestations in systemic lupus erytliematosus Prevalence and association witli antiphospholipid antibodies. J Rlieumatol. 30 985-992. 

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