Saturday, 13 November 2010

MRCP revision battle 48.3: Antiphospholipid syndrome

Antiphospholipid syndrome is characterised by:
  • recurrent venous/arterial thromboses
  • fetal loss
  • thrombocytopenia

Livedo reticularis may also be a feature.

Antiphospholipid syndrome is associated with:
  • lupus anticoagulant - an inhibitor of the coagulation pathway in vitro; pro-coagulant in vivo
  • anti cardiolipin antibodies - IgG and IgM

Management is with aspirin post thrombus, or if recurrent thromboses despite aspirin warfarin.

In pregnancy expert advice is needed; in general aspirin is taken once pregnant and LMWH started once the fetal heart is seen.  This is continued until 34 weeks.   This regime results in 70% success compared with 10% with nothing.

Now for some pictures...