SYNDROME DES ANTIPHOSPHOLIPIES. À PROPOS DE 30 CAS

To analyze clinical and immuno- logic manifestations of Lebanese patients with the antiphos- pholipid syndrome (APS).

Our study was retrospective and was done on hospitalized patients be- tween 2001 and 2013. All these patients fulfilled the interna- tional criteria for diagnosis (Sydney criteria).

Of the 30 patients selected, we noticed a female predominance (sex ratio: 2.75). The age at diagnosis ranged between 9 and 72 years with a mean age of 43 - 17 years. "Primary" APS was present in 70% of patients; APS was associated with systemic lupus erythematosus (SLE) in 23% of patients, with a mixed connective tissue disease in 3% and systemic vasculitis in 3%. A catastrophic APS occurred in 3 cases (10%). The most com- mon presenting manifestations were deep venous thrombosis (53%), pulmonary embolism (33%) and stroke (13%). Eleven patients (37%) had venous thrombosis, 7 (23%) had arterial thrombosis alone and 7 (23%) both arterial and venous throm- bosis. Deep venous thrombosis occurred mostly in the lower limbs (70%) whereas arterial thrombosis occurred in cerebral arteries in 50% of cases. The most common fetal complica- tions were early fetal loss (62.5%). Anticardiolipin antibodies were the most frequently identified antibodies (83%), followed by anti-p2GPI (70%) and anticoagulant lupus (11%). An effec- tive anticoagulation by anti-vitamin K was performed in 29 pa- tients. Corticosteroids were prescribed in 13 cases and were associated to immunosuppressant drugs in 6 cases of second- ary APS and the 3 catastrophic APS. The patients with cat- astrophic APS received also intravenous immunoglobulin. Response to treatment was favorable in 86% of patients with a mean follow up of 6 4 years. We deplored 4 deaths, 2 with- in the catastrophic APS.

The APS does not seem to have particular features in Lebanon. The primary form seems to be the most common. It is important to diagnose this syn- drome earlier before the onset of serious complications.