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Antiphospholipid thrombosis syndromes.

Rodger L Bick1

  • 1Department of Medicine and Pathology, University of Texas Southwestern Medical Center, 10455 North Central Expressway, Suite 109-PMB320, Dallas, TX 75231, USA. rbick@thrombosis.com

Hematology/Oncology Clinics of North America
|March 12, 2003
PubMed
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Antiphospholipid antibodies (ACLAs) are linked to thrombosis. Early diagnosis and specific anticoagulant therapy, like heparin, are crucial for effective secondary prevention in patients with antiphospholipid syndrome.

Area of Science:

  • Hematology
  • Immunology
  • Vascular Medicine

Background:

  • Antiphospholipid antibodies (ACLAs) are a primary cause of acquired thrombophilia.
  • The exact mechanisms by which ACLAs induce a hypercoagulable state are still under investigation.

Purpose of the Study:

  • To highlight the association between ACLAs and various thrombotic events.
  • To emphasize the importance of identifying specific antiphospholipid syndrome types for guiding anticoagulant therapy.
  • To recommend diagnostic testing for individuals with unexplained thrombosis.

Main Methods:

  • Assessment of IgG, IgA, and IgM idiotypes of ACLAs.
  • Classification of antiphospholipid syndrome into types I-VI based on clinical presentation.
  • Utilizing definitive diagnostic tests such as ELISA for ACLA, dilute Russell's viper venom time for lupus anticoagulant (LA), hexagonal phospholipid-neutralization procedure, and beta-2-glycoprotein I (B-2-GP-I) testing.

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Main Results:

  • ACLAs are frequently associated with deep vein thrombosis, pulmonary embolism, arterial thrombosis, and cerebrovascular events.
  • Standard tests like aPTT can be unreliable for diagnosing LA or ACLAs.
  • Many patients with antiphospholipid thrombosis syndrome show poor response to warfarin and some antiplatelet agents.

Conclusions:

  • Prompt diagnosis of antiphospholipid syndrome is vital for effective secondary prevention.
  • Low molecular weight heparin (LMWH) or unfractionated heparin are often the most effective anticoagulants.
  • Clopidogrel may be beneficial in specific cases for secondary prevention.