Clinical Syndromes Associated with Anticardiolipin Antibodies

Description

The finding of a lupus anticoagulant or anticardiolipin antibodies together with thrombosis is termed the antiphospholipid thrombosis syndrome. The thrombosis seen in patients with anticardiolipin antibodies tends to follow a more predictable pattern than that seen in patients with lupus anticoagulants.

The thrombotic syndromes associated with anticardiolipin antibodies can be divided into one of six subgroups based on the pattern of thrombotic findings. The subgroup seen in a patient can help guide appropriate antithrombotic therapy.

Syndrome	Clinical Findings
Type I	deep venous thrombosis with or without pulmonary embolus
Type II	coronary artery thrombosis peripheral artery thrombosis aortic thrombosis carotid artery thrombosis
Type III	retinal artery thrombosis retinal vein thrombosis cerebrovascular thrombosis transient cerebral ischemic attacks
Type IV	mixtures of types I, II and III rare
Type V	fetal wastage placental vascular thrombosis maternal thrombocytopenia (uncommon)
Type VI	laboratory evidence of antiphospholipid antibody no apparent clinical manifestations

Syndrome	Antithrombotic Regimens
Type I	intravenous or subcutaneous heparin followed by long-term self-administration of subcutaneous porcine or LMW heparin
Type II	intravenous or subcutaneous heparin followed by long-term self-administration of subcutaneous porcine or LMW heparin
Type III	retinal: pentoxiphylline (400 mg tid) cerebrovascular: long term low dose warfarin plus low dose ASA , or long term self administration of subcutaneous porcine or LMW heparin
Type IV	according to Type I, II and/or III (above)
Type V	low dose ASA (81 mg/day) pre-conception; addition of fixed low dose porcine heparin (5,000 U every 12 hours) immediately after conception
Type VI	no clear indications for antithrombotic therapy

Long-term antithrombotic therapy should not be stopped unless the anticardiolipin antibody has been absent for the preceding 4-6 months.

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Clinical Syndromes Associated with Anticardiolipin Antibodies

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