Facts and Figures

THE MOSAIC OF ANTIPHOSPHOLIPID SYNDROME (APS)

Additional interesting aspects of Antiphospholipid Syndrome (APS or APLS) raised by presenters included:

1. High titers of aCL in advanced coronary atherosclerosis (I. Stankulov).
2. The appearance of aCL often with myocardial infarction.
3. The 5% to 10% incidence of epilepsy in Antiphospholipid Syndrome (APS or APLS), related to the effect of aCL on the central nervous system.
4. The 29% of aCL positivity in sera of patients (I. Kokareshkov) with multiple sclerosis.

All the above indicates that indeed Antiphospholipid Syndrome (APS or APLS) is a multi-disciplinary disease.

Precipitating factors in 80 patients with catastrophic Antiphospholipd Syndrome (CAPS)

Criteria for the Diagnosis of Antiphospholipid Antibody Syndrome

Clinical	Laboratory
· Recurrent venous thrombosis · Recurrent arterial thrombosis · Recurrent fetal loss+ · Persistent thrombocytopenia · Livedo reticularis	IgG or IgM anticardiolipin (anti-B2-glycoprotein-I dependent) antibody (> 20 IU) ++ Lupus anticoagulant*

Patients must have at least one clinical and 1 laboratory finding and laboratory test result must be positive on at least 2 occasions more than 3 months apart.
+ As defined by Branch and Silver. (At least 3 spontaneous abortions, fetal death,or early neonatal death due to preterm delivery required because of fetal distress. )¹
This may soon be supplanted by a direct test for antibody to B2-glycoprotein-I.
*Phospholipid-dependent screening test, such as activated partial thromboplastin time, must be abnormal.

Treatment

For recurrent manifestations of Antiphospholipid Syndrome (APS or APLS) anticoagulation is the treatment of choice. For treatment of recurrent fetal loss heparin and aspirin increases survival from 40% to 80% 25.

Recent Treatment Studies in Antiphospholipid Antibody Syndrome*

Condition	Study	Type	Comparison	Conclusion	Comment
Clot (all)	Khamashta et al11	Retrospective	Aspirin vs warfarin	INR> 3 protective	INR may be an invalid test
Clot (stroke)	Brey and Levine29	RCT	Aspirin vs warfarin sodium, different warfarin doses	In progress	...
Clot (venous)	Ginsberg et al	RCT	Different warfarin doses	Moderate dose sufficient	15% recurrence at 6 mo after discontinuati on
Pregnancy	Cowchock et al	RCT	Aspirin + heparin vs Aspirin + Prednisone	Aspirin + heparin better	Small study
Pregnancy	Pregnancy Loss Study Group	RCT	Aspirin + heparin vs IVIG	In progress	...
Pregnancy	Kutteh	RCT	Aspirin vs heparin, different heparin doses	Heparin better, low dose as effective as high dose	Small study

INR indicates international normalized ratio;RCT,

randomized controlled trial; and IVIG, intravenous immunoglobulin.

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