Antiphospholipid Antibodies and Antiphospholipid Syndrome: Diagnosis and Management

García-García, C.

doi:10.1016/S1578-2190(07)70385-2

Article information

Abstract

The antiphospholipid syndrome is an acquired autoimmune thrombophilia that produces significant morbidity and mortality. Its diagnosis requires the presence of antiphospholipid antibodies and clinical manifestations that include thrombotic phenomena and/or recurrent miscarriages. The antiphospholipid antibodies may be detected in many instances, including healthy subjects without an underlying disease. The clinical manifestations are varied and may occur in episodes and also appear in other situations. Therefore, it is important to have clear guidelines in order to establish a correct diagnosis, carry out an adequate treatment, and to know which are the prophylactic measures and when they should be undertaken. In this article we explain the most recent diagnostic criteria reviewed in the 11th International Congress on Antiphospholipid Antibodies (Sydney 2004), comment on the varied clinical manifestations with special focus on cutaneous lesions, and revise current guidelines for the treatment and prophylaxis of thrombotic and obstetric pathology.

Key words:

antiphospholipid antibodies

antiphospholipid syndrome

thrombophilia

Resumen

El síndrome antifosfolípido es una forma de trombofilia autoinmune adquirida que produce una morbilidad y mortalidad importantes. Su diagnóstico exige la presencia de anticuerpos antifosfolípido y unas manifestaciones clínicas que incluyen fenómenos trombóticos y/o pérdidas fetales recurrentes. Los anticuerpos antifosfolípido se pueden detectar en muchas situaciones, incluyendo la población sana sin provocar enfermedad, y la clínica, que es muy variada, puede ocurrir de forma episódica y aparecer en otras situaciones, por lo tanto es preciso tener unas pautas claras para establecer correctamente su diagnóstico, realizar un tratamiento adecuado del cuadro ya establecido, y conocer las medidas preventivas que debemos tomar y cuándo ponerlas en marcha. En este trabajo exponemos los últimos criterios diagnósticos revisados en el Decimoprimer Congreso Internacional sobre anticuerpos antifosfolípido de Sydney 2004, comentamos las variadas manifestaciones clínicas del cuadro con especial mención a las lesiones cutáneas, y hacemos un repaso de las pautas que se proponen en este momento para el tratamiento y prevención de la patología trombótica y obstétrica.

Palabras clave:

anticuerpos antifosfolípido

síndrome antifosfolípido

trombofilia

Full text is only aviable in PDF

References

[1.]

J. Alijotas.

Hacia la comprensión de la heterogeneidad de las manifestaciones clínicas asociadas a los anticuerpos antifosfolípidos.

Med Clin (Barc), 125 (2005), pp. 187-189

[2.]

J.T. Brandt, D.A. Triplett, B. Alving, I. Scharrer.

Criteria for the diagnosis of lupus anticoagulants: an update.

Thromb Haemost, 74 (1995), pp. 1185-1190

Medline

[3.]

S. Miyakis, M.D. Lockshin, T. Atsumi, D.W. Branch, R.L. Brey, R. Cervera, et al.

International consensus statement on an update of the classification criteria for definitive antiphospholipid syndrome.

J Thromb Haemost, 4 (2006), pp. 295-306

http://dx.doi.org/10.1111/j.1538-7836.2006.01753.x | Medline

[4.]

M. Galli.

Antiphospholipid antibodies and thrombosis: do test patterns identify the patients’ risk?.

Thromb Res, 114 (2004), pp. 597-601

http://dx.doi.org/10.1016/j.thromres.2004.08.009 | Medline

[5.]

V. Pengo, B. Alessandra, P. Cinzia, U. Cucchini, F. Noventa, S. Iliceto.

Antibody profiles for the diagnosis of antiphospholipid syndrome.

Thromb Haemost, 93 (2005), pp. 1147-1152

http://dx.doi.org/10.1160/TH04-12-0839 | Medline

[6.]

R. Cervera, J. Font, A. Tincani, M.-C. Boffa.

V meeting of the European forum on antiphospholipid antibodies.

Autoinmun Rev, 5 (2006), pp. 499-507

[7.]

W.A. Wilson, A.E. Gharavi, T. Koike, M.D. Lockshin, D.W. Branch, J.C. Piette, et al.

International consensus statement on preliminary classification criteria for definitive antiphospholipid syndrome: report of an international workshop.

Arthritis Rheum, 42 (1999), pp. 1309-1311

http://dx.doi.org/10.1002/1529-0131(199907)42:7<1309::AID-ANR1>3.0.CO;2-F | Medline

[8.]

R. Cervera, J.-C. Piette, J. Font, M.A. Khamashta, Y. Shoenfeld, M.T. Camps, et al.

Antiphospholipid Syndrome. Clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients.

Arthritis Rheum, 46 (2002), pp. 1019-1027

Medline

[9.]

C. Francès, S. Niang, E. Laffitte, F. Pelletier, N. Costedoat, J.C. Piette.

Dermatologic manifestations of antiphospholipid syndrome. Two hundred consecutive cases.

Arthritis Rheum, 52 (2005), pp. 1785-1793

http://dx.doi.org/10.1002/art.21041 | Medline

[10.]

C. Mackworth-Young.

Primary antiphospholipid syndrome: A distinct entity?.

Autoinmun Rev, 5 (2006), pp. 70-75

[11.]

J.A. Gómez-Puerta, H. Martín, M.C. Amigo, M.A. Aguirre, M.T. Camps, M.J. Cuadrado, et al.

Long-term follow-up in 128 patients with primary antiphospholipid syndrome: do they develop Lupus?.

Medicine (Baltimore), 84 (2005), pp. 225-230

[12.]

B. Robertson, M. Greaves.

Antiphospholipid syndrome: An evolving story.

Blood Rev, 20 (2006), pp. 201-212

http://dx.doi.org/10.1016/j.blre.2005.12.001 | Medline

[13.]

J.S. Levine, D.W. Branch, J. Rauch.

The antiphospholipid syndrome.

N Eng J Med, 346 (2002), pp. 752-763

[14.]

R.A. Asherson, R. Cervera, J.C. Piette, L. Font, J.T. Lie, A. Burcoglu, et al.

Catastrophic antiphospholipid syndrome. Clinical and laboratory features of 50 patients.

Medicine (Baltimore), 77 (1998), pp. 195-207

[15.]

R. Cervera, R.A. Asherson.

Catastrophic antiphospholipid syndrome.

Pathophysiol Haemat Thromb, 35 (2006), pp. 181-186

[16.]

R.A. Asherson, C. Francès, L. Iaccarino, M.A. Khamastha, F. Malacarne, J.C. Piette, et al.

The antiphospholipid antibody syndrome: diagnosis, skin manifestations and current therapy.

Clin Exp Rheumatol, 24 (2006), pp. S46-S51

Medline

[17.]

D. Alarcón-Segovia, M.C. Boffa, W. Branco, R. Cervera, A. Gharavi, M. Khamashta, et al.

Prophylaxis of the antiphospholipid syndrome: a consensus report.

Lupus, 12 (2003), pp. 499-505

Medline

[18.]

P. DeMarco, I. Singh, A. Weinstein.

Management of the antiphospholipid syndrome.

Curr Rheumat Rep, 8 (2006), pp. 114-120

[19.]

M. Petri.

Hydroxycloroquine use in the Baltimore Lupus Cohort: effects on lipids, glucose and thrombosis.

Lupus, 5 (1996), pp. S16-S22

Medline

[20.]

M. Lim, M.A. Crowther, J.W. Eikelboom.

Management of antiphospholipid antibody syndrome.

JAMA, 295 (2006), pp. 1050-1057

http://dx.doi.org/10.1001/jama.295.9.1050 | Medline

[21.]

M.A. Crowther, F. Wisloff.

Evidence based treatment of the antiphospholipid syndrome II. Optimal anticoagulant therapy for thrombosis.

Thromb Res, 115 (2005), pp. 3-8

http://dx.doi.org/10.1016/j.thromres.2004.06.041 | Medline

[22.]

T.L. Ortell.

The antiphospholipid syndrome: What are we really measuring? How do we measure it? And how do we treat it?.

J Thromb Thrombolysis, 21 (2006), pp. 79-83

http://dx.doi.org/10.1007/s11239-006-5581-x | Medline

[23.]

M.L. Bertolaccini, M.A. Khamashta.

Laboratory diagnosis and management challenges in the antiphospholipid syndrome.

Lupus, 15 (2006), pp. 172-178

Medline

Indexed in:

Follow us:

Indexed in:

Follow us:

Subscribe to our newsletter