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Lupus, antiphospholipid syndrome, and stroke: An attempt to crossmatch

Georges El Hasbani1, Imad Uthman2

  • 1Department of Internal Medicine, St Vincent's Medical Center, Bridgeport, CT, USA.

Lupus
|March 20, 2023
PubMed

Insights

Systemic Lupus Erythematosus and Antiphospholipid Syndrome increase stroke risk, particularly with antiphospholipid antibodies. Management focuses on prevention and anticoagulation, though optimal strategies require further research.

Area of Science:

  • Rheumatology
  • Neurology
  • Hematology

Background:

  • Cerebrovascular accidents (CVAs), or strokes, are frequent thrombotic events in Systemic Lupus Erythematosus (SLE) and Antiphospholipid Syndrome (APS).
  • Antiphospholipid antibodies (aPLs) significantly increase stroke incidence in SLE patients, often affecting large cerebral vessels.
  • Mechanisms involve neuroinflammation and blood-brain barrier disruption, alongside traditional cardiovascular risk factors.

Purpose of the Study:

  • To review the role of antiphospholipid antibodies in stroke pathogenesis within SLE and APS.
  • To discuss current and potential therapeutic strategies for stroke prevention and management in these conditions.
  • To highlight knowledge gaps regarding non-criteria aPLs and anticoagulation efficacy.

Main Methods:

  • Literature review of studies on stroke in SLE and APS.
  • Analysis of the impact of criteria and non-criteria antiphospholipid antibodies on cerebrovascular events.
  • Evaluation of current management guidelines for primary and secondary stroke prevention.

Main Results:

  • Presence of aPLs, including specific non-criteria antibodies, is an independent stroke risk factor.
  • Warfarin is a secondary prevention tool, but optimal targets and combination therapies remain debated.
  • Limited data exists on Direct Oral Anticoagulants (DOACs) for stroke in these patient populations.

Conclusions:

  • Stroke in SLE/APS is multifactorial, with aPLs playing a key role.
  • Primary prevention involves antiplatelet agents and SLE disease control.
  • Further research is needed to clarify anticoagulation strategies, especially concerning novel agents and non-criteria aPLs.

Keywords:
Systemic lupus erythematosusantiphospholipid syndromecerebrovascular accidentsclinical presentationmanagementpathophysiologyprevalence

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