Antiphospholipid syndrome presenting with acute stroke: case series and review of literature
Keywords:
antiphospholipid syndrome, antiphospholipid antibodies, stroke, cerebrovascular diseaseAbstract
Antiphospholipid syndrome (APS) is an uncommon systemic autoimmune disease characterized by venous or arterial thrombosis and pregnancy complications in the context of persistent antiphospholipid antibodies. Clinical presentation of APS patients may vary depending on the organ systems affected. Recognition of APS among patients who present with acute stroke is difficult and often leads to delayed diagnosis or excessive investigations. Three patients who came to Thammasat University Hospital with acute stroke and were eventually diagnosed with APS are presented. The epidemiology, risk factors, clinical features, immunological profiles, radiographic findings, principle of diagnosis, along with treatment and outcomes of APS patients presenting with acute stroke are reviewed.
References
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Asherson RA, Khamashta MA, Ordi-Ros J, et al. The “primary” antiphospholipid syndrome: major clinical and serological features. Medicine
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Oku K, Nakamura H, Kono M, et al. Complement and thrombosis in the antiphospholipid syndrome. Autoimmun Rev. 2016.
Nayfe R, Uthman I, Aoun J, et al. Seronegative antiphospholipid syndrome. Rheumatology (Oxford). 2013;52(8):1358-67.
Kazzaz NM, McCune WJ, Knight JS. Treatment of catastrophic antiphospholipid syndrome. Curr Opin Rheumatol. 2016.
Biggioggero M, Meroni PL. The geoepidemiology of the antiphospholipid antibody syndrome. Autoimmun Rev. 2010;9(5):A299-304.
Muscal E, Brey RL. Antiphospholipid syndrome and the brain in pediatric and adult patients. Lupus. 2010;19(4):406-11.
Cervera R, Boffa MC, Khamashta MA, et al. The Euro-Phospholipid project: epidemiology of the antiphospholipid syndrome in Europe. Lupus. 2009;18(10):889-93.
Garcia-Carrasco M, Galarza C, Gomez-Ponce M, et al. Antiphospholipid syndrome in Latin American patients: clinical and immunologic characteristics and comparison with European patients. Lupus. 2007;16(5):366-73.
Yoon KH, Fong KY, Sivalingam P, et al. Antiphospholipid syndrome in Asians: clinical manifestations, serological markers and outcome of the National University of Singapore/National University Hospital antiphospholipid cohort. APLAR J Rheumatol. 2003;6:128-36.
Tan BE, Thong BY, Shivananda S, et al. Clinical manifestations and outcomes of antithrombotic treatment of the Tan Tock Seng Hospital Singapore
antiphospholipid syndrome cohort. Lupus. 2009;18(8):752-8.
Fujieda Y, Atsumi T, Amengual O, et al. Predominant prevalence of arterial thrombosis in Japanese patients with antiphospholipid syndrome. Lupus. 2012;21(14):1506-14.
Pengo V, Biasiolo A, Pegoraro C, et al. Antibody profiles for the diagnosis of antiphospholipid syndrome. Thrombosis and haemostasis. 2005;93(6):1147-52.
Urbanus RT, Siegerink B, Roest M, et al. Antiphospholipid antibodies and risk of myocardial infarction and ischaemic stroke in young women in the RATIO study: a case-control study. Lancet Neurol. 2009;8(11):998-1005.
Rodriguez-Sanz A, Martinez-Sanchez P, Prefasi D, et al. Antiphospholipid antibodies correlate with stroke severity and outcome in patients with antiphospholipid syndrome. Autoimmunity. +2015;48(5):275-81.
Erkan D, Yazici Y, Peterson MG, et al. A crosssectional study of clinical thrombotic risk factors and preventive treatments in antiphospholipid syndrome. Rheumatology (Oxford). 2002;41(8):924-9.
de Souza AW, Silva NP, de Carvalho JF, et al. Impact of hypertension and hyperhomocysteinemia on arterial thrombosis in primary antiphospholipid
syndrome. Lupus. 2007;16(10):782-7.
Provenzale JM, Barboriak DP, Allen NB, et al. Patients with antiphospholipid antibodies: CT and MR findings of the brain. AJR American journal of roentgenology. 1996;167(6):1573-8.
Zhu DS, Fu J, Zhang Y, et al. Neurological antiphospholipid syndrome: Clinical, neuroimaging, and pathological characteristics. Journal of the neurological sciences. 2014;346(1-2):138-44.
Verro P, Levine SR, Tietjen GE. Cerebrovascular ischemic events with high positive anticardiolipin antibodies. Stroke. 1998;29(11):2245-53.
Rodrigues CE, Carvalho JF, Shoenfeld Y. Neurological manifestations of antiphospholipid syndrome. Eur J Clin Invest. 2010;40(4):350-9.
Wu S, Xu Z, Liang H. Sneddon’s syndrome: a comprehensive review of the literature. Orphanet journal of rare diseases. 2014;9:215.
Miyakis S, Lockshin MD, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006;4(2):295-306.
Pengo V, Tripodi A, Reber G, et al. Update of the guidelines for lupus anticoagulant detection. Subcommittee on Lupus Anticoagulant/Antiphospholipid Antibody of the Scientific and Standardisation Committee of the International Society on Thrombosis and Haemostasis. J Thromb Haemost. 2009;7(10):1737-40.
Pengo V. ISTH guidelines on lupus anticoagulant testing. Thromb Res. 2012;130 Suppl 1:S76-7.
Pengo V, Banzato A, Bison E, et al. Laboratory testing for antiphospholipid syndrome. Int J Lab Hematol. 2016.
Ruiz-Irastorza G, Cuadrado MJ, Ruiz-Arruza I, et al. Evidence-based recommendations for the prevention and long-term management of thrombosis in antiphospholipid antibody-positive patients: report of a task force at the 13th International Congress on antiphospholipid antibodies. Lupus. 2011;20(2):206-18.
Pengo V, Ruffatti A, Del Ross T, et al. Confirmation of initial antiphospholipid antibody positivity depends on the antiphospholipid antibody profile. J Thromb Haemost. 2013;11(8):1527-31.
Tektonidou MG, Laskari K, Panagiotakos DB, et al. Risk factors for thrombosis and primary thrombosis prevention in patients with systemic lupus erythematosus with or without antiphospholipid antibodies. Arthritis Rheum. 2009;61(1):29-36.
Sciascia S, Lopez-Pedrera C, Cecchi I, et al. Nonvitamin K antagonist oral anticoagulants and antiphospholipid syndrome. Rheumatology (Oxford). 2016.
Cervera R, Serrano R, Pons-Estel GJ, et al. Morbidity and mortality in the antiphospholipid syndrome during a 10-year period: a multicentre prospective study of 1000 patients. Ann Rheum Dis. 2015;74(6):1011-8.
Asherson RA, Khamashta MA, Ordi-Ros J, et al. The “primary” antiphospholipid syndrome: major clinical and serological features. Medicine
(Baltimore). 1989;68(6):366-74.
Meroni PL, Borghi MO, Raschi E, et al. Pathogenesis of antiphospholipid syndrome: understanding the antibodies. Nature reviews Rheumatology.
2011;7(6):330-9.
Oku K, Nakamura H, Kono M, et al. Complement and thrombosis in the antiphospholipid syndrome. Autoimmun Rev. 2016.
Nayfe R, Uthman I, Aoun J, et al. Seronegative antiphospholipid syndrome. Rheumatology (Oxford). 2013;52(8):1358-67.
Kazzaz NM, McCune WJ, Knight JS. Treatment of catastrophic antiphospholipid syndrome. Curr Opin Rheumatol. 2016.
Biggioggero M, Meroni PL. The geoepidemiology of the antiphospholipid antibody syndrome. Autoimmun Rev. 2010;9(5):A299-304.
Muscal E, Brey RL. Antiphospholipid syndrome and the brain in pediatric and adult patients. Lupus. 2010;19(4):406-11.
Cervera R, Boffa MC, Khamashta MA, et al. The Euro-Phospholipid project: epidemiology of the antiphospholipid syndrome in Europe. Lupus. 2009;18(10):889-93.
Garcia-Carrasco M, Galarza C, Gomez-Ponce M, et al. Antiphospholipid syndrome in Latin American patients: clinical and immunologic characteristics and comparison with European patients. Lupus. 2007;16(5):366-73.
Yoon KH, Fong KY, Sivalingam P, et al. Antiphospholipid syndrome in Asians: clinical manifestations, serological markers and outcome of the National University of Singapore/National University Hospital antiphospholipid cohort. APLAR J Rheumatol. 2003;6:128-36.
Tan BE, Thong BY, Shivananda S, et al. Clinical manifestations and outcomes of antithrombotic treatment of the Tan Tock Seng Hospital Singapore
antiphospholipid syndrome cohort. Lupus. 2009;18(8):752-8.
Fujieda Y, Atsumi T, Amengual O, et al. Predominant prevalence of arterial thrombosis in Japanese patients with antiphospholipid syndrome. Lupus. 2012;21(14):1506-14.
Pengo V, Biasiolo A, Pegoraro C, et al. Antibody profiles for the diagnosis of antiphospholipid syndrome. Thrombosis and haemostasis. 2005;93(6):1147-52.
Urbanus RT, Siegerink B, Roest M, et al. Antiphospholipid antibodies and risk of myocardial infarction and ischaemic stroke in young women in the RATIO study: a case-control study. Lancet Neurol. 2009;8(11):998-1005.
Rodriguez-Sanz A, Martinez-Sanchez P, Prefasi D, et al. Antiphospholipid antibodies correlate with stroke severity and outcome in patients with antiphospholipid syndrome. Autoimmunity. +2015;48(5):275-81.
Erkan D, Yazici Y, Peterson MG, et al. A crosssectional study of clinical thrombotic risk factors and preventive treatments in antiphospholipid syndrome. Rheumatology (Oxford). 2002;41(8):924-9.
de Souza AW, Silva NP, de Carvalho JF, et al. Impact of hypertension and hyperhomocysteinemia on arterial thrombosis in primary antiphospholipid
syndrome. Lupus. 2007;16(10):782-7.
Provenzale JM, Barboriak DP, Allen NB, et al. Patients with antiphospholipid antibodies: CT and MR findings of the brain. AJR American journal of roentgenology. 1996;167(6):1573-8.
Zhu DS, Fu J, Zhang Y, et al. Neurological antiphospholipid syndrome: Clinical, neuroimaging, and pathological characteristics. Journal of the neurological sciences. 2014;346(1-2):138-44.
Verro P, Levine SR, Tietjen GE. Cerebrovascular ischemic events with high positive anticardiolipin antibodies. Stroke. 1998;29(11):2245-53.
Rodrigues CE, Carvalho JF, Shoenfeld Y. Neurological manifestations of antiphospholipid syndrome. Eur J Clin Invest. 2010;40(4):350-9.
Wu S, Xu Z, Liang H. Sneddon’s syndrome: a comprehensive review of the literature. Orphanet journal of rare diseases. 2014;9:215.
Miyakis S, Lockshin MD, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006;4(2):295-306.
Pengo V, Tripodi A, Reber G, et al. Update of the guidelines for lupus anticoagulant detection. Subcommittee on Lupus Anticoagulant/Antiphospholipid Antibody of the Scientific and Standardisation Committee of the International Society on Thrombosis and Haemostasis. J Thromb Haemost. 2009;7(10):1737-40.
Pengo V. ISTH guidelines on lupus anticoagulant testing. Thromb Res. 2012;130 Suppl 1:S76-7.
Pengo V, Banzato A, Bison E, et al. Laboratory testing for antiphospholipid syndrome. Int J Lab Hematol. 2016.
Ruiz-Irastorza G, Cuadrado MJ, Ruiz-Arruza I, et al. Evidence-based recommendations for the prevention and long-term management of thrombosis in antiphospholipid antibody-positive patients: report of a task force at the 13th International Congress on antiphospholipid antibodies. Lupus. 2011;20(2):206-18.
Pengo V, Ruffatti A, Del Ross T, et al. Confirmation of initial antiphospholipid antibody positivity depends on the antiphospholipid antibody profile. J Thromb Haemost. 2013;11(8):1527-31.
Tektonidou MG, Laskari K, Panagiotakos DB, et al. Risk factors for thrombosis and primary thrombosis prevention in patients with systemic lupus erythematosus with or without antiphospholipid antibodies. Arthritis Rheum. 2009;61(1):29-36.
Sciascia S, Lopez-Pedrera C, Cecchi I, et al. Nonvitamin K antagonist oral anticoagulants and antiphospholipid syndrome. Rheumatology (Oxford). 2016.
Cervera R, Serrano R, Pons-Estel GJ, et al. Morbidity and mortality in the antiphospholipid syndrome during a 10-year period: a multicentre prospective study of 1000 patients. Ann Rheum Dis. 2015;74(6):1011-8.
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2019-02-13
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จตุวรพฤกษ์ ก. Antiphospholipid syndrome presenting with acute stroke: case series and review of literature. J Thai Stroke Soc [Internet]. 2019 Feb. 13 [cited 2024 Nov. 13];16(1):5-15. Available from: https://he01.tci-thaijo.org/index.php/jtss/article/view/172084
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