Advertisement

Management of Patients with Antiphospholipid Antibodies

  • B. Alving
Conference paper

Abstract

Antiphospholipid antibodies, which are detected in coagulation assays as lupus anticoagulants (LA) or in solid-phase ELISAs as anticardiolipin antibodies (ACA), have been recognized in many different clinical settings for the past forty years. The antibodies appear to be an incidental finding in patients who have infections or who are using medications such as procainamide or quinidine. However, in patients who have systemic lupus erythematosus (SLE) or other autoimmune connective tissue disorders or in those who may have no apparent autoimmune disorder, the presence of antiphospholipid antibodies indicates an increased risk for thrombosis, fetal loss, or thrombocytopenia.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Bowie EJW, Thompson JH jr, Pascuzzi CA, Owen CA jr (1963) Thrombosis in systemic lupus erythematosus despite circulating anticoagulants. J Lab Clin Med 62: 416–430PubMedGoogle Scholar
  2. 2.
    Gastineau DA, Kazmier FJ, Nichols WL, Bowie EJW (1985) Lupus anticoagulant: an analysis of the clinical and laboratory features of 219 cases. Am J Hematol 19: 265–275PubMedCrossRefGoogle Scholar
  3. 3.
    Harris EN, Gharavi EA, Boey ML et al (1983) Anticardiolipin antibodies: detection by radioimmunoassay and association with thrombosis in systemic lupus erythematosus. Lancet 11: 1211–1214CrossRefGoogle Scholar
  4. 4.
    Asherson RA, Khamashta MA, Ordi-Ros J et al (1989) The “primary” antiphospholipid syndrome: major clinical and serological features. Medicine 68: 366–374PubMedCrossRefGoogle Scholar
  5. 5.
    Harris EN. The anti-phospholipid syndrome - an introduction. In: Harris EN, Exner T, Hughes GRV, Asherson RA (eds) Phospholipid-binding antibodies. CRC, Boston, pp 373–376Google Scholar
  6. 6.
    Asherson RA (1988) A “primary” antiphospholipid syndrome? J Rheumatol 15: 1742–1745PubMedGoogle Scholar
  7. 7.
    Asherson RA (1991) “Primary” anti-phospholipid syndrome. In: Harris EN, Exner T, Hughes GRV, Asherson RA (eds) Phospholipid-binding antibodies. CRC, Boston, pp 378–386Google Scholar
  8. 8.
    Harris EN (1990) Annotation. Antiphospholipid antibodies. Br J Haematol 74: 1–9PubMedCrossRefGoogle Scholar
  9. 9.
    Hughes GRV, Harris EN, Gharavi AE (1986) The anticardiolipin syndrome. J Rheumatol 13: 486–489PubMedGoogle Scholar
  10. 10.
    Mackworth-Young CG, Loizou S, Walport MJ (1989) Primary antiphospholipid syndrome: features of patients with raised anticardiolipin antibodies and no other disorder. Ann Rheum Dis 48: 362–367PubMedCrossRefGoogle Scholar
  11. 11.
    Asherson RA (1991) Anti-phospholipid antibodies. Clinical complications reported in medical literature. In: Harris EN, Exner T, Hughes GRV, Asherson RA (eds) Phospholipid-binding antibodies. CRC, Boston, pp 388–402Google Scholar
  12. 12.
    Samaritano LR, Gharavi AE, Lockshin MD (1990) Antiphospholipid antibody syndrome: immunologic and clinical aspects. Semin Arthritis Rheum 20: 81–96CrossRefGoogle Scholar
  13. 13.
    Boey ML, Colaco CB, Gharavi AE, Elkon KB, Loizou S, Hughes GRV (1983) Thrombosis in systemic lupus erythematosus: striking association with the presence of circulating lupus anticoagulant. Br Med J 287: 1021–1023CrossRefGoogle Scholar
  14. 14.
    Long AA, Ginsberg JS, Brill-Edwards P et al (1991) The relationship of antiphospholipid antibodies to thromboembolic disease in systemic lupus erythematosus: a cross-sectional study. Thromb Haemost 66: 520–524PubMedGoogle Scholar
  15. 15.
    Cronin Me, Biswas RM, Van der Straeton C, Fleisher TA, Klippel JH (1988) IgG and IgM anticardiolipin antibodies in patients with lupus with anticardiolipin antibody associated clinical syndromes. J Rheumatol 15: 795–798PubMedGoogle Scholar
  16. 16.
    Love PE, Santoro SA (1990) Antiphospholipid antibodies: anticardiolipin and the lupus anticoagulant in systemic lupus erythematosus (SLE) and in non-SLE disorders. Ann Intern Med 112: 682–698PubMedGoogle Scholar
  17. 17.
    Petri M, Rheinschmidt M, Whiting-O’Keefe Q, Hellmann D, Corash L (1987) The frequency of lupus anticoagulant in systemic lupus erythematosus: a study of sixty consecutive patients by activated partial thromboplastin time, Russell viper venom time, and anticardiolipin antibody level. Ann Intern Med 106: 524–531PubMedGoogle Scholar
  18. 18.
    Mackworth-Young C, Chan J, Harris N et al (1987) High incidence of anticardiolipin antibodies in relatives of patients with systemic lupus erythematosus. J Rheumatol 14: 723–726PubMedGoogle Scholar
  19. 19.
    Arnett FC, Olsen ML, Anderson KL, Reveille JD (1991) Molecular analysis of major histocompatibility complex alleles associated with the lupus anticoagulant. J Clin Invest 87: 1490–1495PubMedCrossRefGoogle Scholar
  20. 20.
    Ishii Y, Nagasawa K, Mayumi T, Niho Y (1990) Clinical importance of persistence of anticardiolipin antibodies in systemic lupus erythematosus. Ann Rheum Dis 49: 387–390PubMedCrossRefGoogle Scholar
  21. 21.
    Asherson RA, Merry P, Acheson JF, Harris EN, Hughes GRV (1989) Antiphospholipid antibodies: A risk factor for occlusive ocular vascular disease in systemic lupus erythematosus and the ‘primary’ antiphospholipid syndrome. Ann Rheum Dis 48: 358–361PubMedCrossRefGoogle Scholar
  22. 22.
    Harris EN, Asherson RA, Gharavi AE, Morgan SH, Derue G, Hughes GRV (1985) Thrombocytopenia in SLE and related autoimmune disorders: association with anticardiolipin antibody. Br J Haematol 59: 227–230PubMedCrossRefGoogle Scholar
  23. 23.
    Levine SR, Deegan MJ, Futrell N, Welch KM A (1990) Cerebrovascular and neurologic disease associated with antiphospholipid antibodies: 48 cases. Neurology 40: 1181–1189PubMedGoogle Scholar
  24. 24.
    Asherson RA, Khamashta MA, Gil A et al (1989) Cerebrovascular disease and antiphospholipid antibodies in systemic lupus erythematosus, lupus-like disease, and the primary antiphospholipid syndrome. Am J Med 86: 391–399PubMedCrossRefGoogle Scholar
  25. 25.
    Brey RL, Hart RG, Sherman DG, Tegeler CH (1990) Antiphospholipid antibodies and cerebral ischemia in young people. Neurology 40: 1190–1196PubMedGoogle Scholar
  26. 26.
    Olsen ML, O’Conner S, Arnett FC, Rosenbaum D, Grotta JC, Warner NB (1991) Auto-antibodies and rheumatic disorders in a neurology inpatient population: a prospective study. Am J Med 90: 479–488PubMedGoogle Scholar
  27. 27.
    Trimble M, Bell DA, Brien W et al (1990) The antiphospholipid syndrome: prevalence among patients with stroke and transient ischemic attacks. Am J Med 88: 593–597PubMedCrossRefGoogle Scholar
  28. 28.
    Kushner MJ (1990) Prospective study of anticardiolipin antibodies in stroke. Stroke 21: 295–298PubMedCrossRefGoogle Scholar
  29. 29.
    Montalban J, Codina A, Ordi J, Vilardell M, Khamashta MA, Hughes GRV (1991) Antiphospholipid antibodies in cerebral ischemia. Stroke 22: 750–753PubMedCrossRefGoogle Scholar
  30. 30.
    Hess DC, Krauss J, Adams RJ, Nichols FT, Zhang D-I, Rountree HA (1991) Anticardiolipin antibodies: study of frequency in TIA and stroke. Neurology 41: 525–528PubMedGoogle Scholar
  31. 31.
    Elias M, Eldor A (1984) Thromboembolism in patients with the ‘lupus’-type circulating anticoagulant. Arch Intern Med 144: 510–515PubMedCrossRefGoogle Scholar
  32. 32.
    Lechner K, Pabinger-Fasching I (1985) Lupus anticoagulants and thrombosis. A study of 25 cases and review of the literature. Haemostasis 15: 254–262PubMedGoogle Scholar
  33. 33.
    Rosove MH, Brewer PMC (1992) Antiphospholipid thrombosis: clinical course after the first thrombotic event in 70 patients. Ann Intern Med 117: 303–308PubMedGoogle Scholar
  34. 34.
    Cowchock S (1991) The role of antiphospholipid antibodies in obstetric medicine. Curr Obstetr Med 1: 229–247Google Scholar
  35. 35.
    Infante-Rivard C, David M, Gauthier R, Rivard GE (1991) Lupus anticoagulants, anti-cardiolipin antibodies, and fetal loss. A case-control study. N Engl J Med 325: 1063–1066PubMedCrossRefGoogle Scholar
  36. 36.
    Lockwood CJ, Romero R, Feinberg RF, Clyne LP, Coster B, Hobbins JC (1989) The prevalence and biologic significance of lupus anticoagulant and anticardiolipin antibodies in a general obstetric population. Am J Obstet Gynecol 161: 369–373PubMedGoogle Scholar
  37. 37.
    Unander AM, Norberg R, Hahn L, Arfors L (1987) Anticardiolipin antibodies and complement in ninety-nine women with habitual abortion. Am J Obstet Gynecol 156: 114–119PubMedGoogle Scholar
  38. 38.
    Branch DW, Andres R, Digre KB, Rote NS, Scott JR (1989) The association of antiphospholipid antibodies with severe preeclampsia. Obstet Gynecol 73: 541–545PubMedGoogle Scholar
  39. 39.
    Harris EN, Chan JKH, Asherson RA, Aber VR, Gharavi AE, Hughes GRV (1986) Thrombosis, recurrent fetal loss and thrombocytopenia. Arch Intern Med 146: 2153–2156PubMedCrossRefGoogle Scholar
  40. 40.
    Derue GJ, Englert HJ, Harris EN et al (1985) Fetal loss in systemic lupus: association with anticardiolipin antibodies. J Obstet Gynecol 5: 207–209CrossRefGoogle Scholar
  41. 41.
    Lockshin MD, Druzin ML, Goei S et al (1985) Antibody to cardiolipin as a predictor of fetal distress or death in pregnant patients with systemic lupus erythematosus. N Engl J Med 313: 152–160PubMedCrossRefGoogle Scholar
  42. 42.
    Ordi J, Barquinero J, Vilardell M et al (1989) Fetal loss treatment in patients with anti-phospholipid antibodies. Ann Rheum Dis 48: 798–802PubMedCrossRefGoogle Scholar
  43. 43.
    Lübbe WF, Butler WS, Palmer SJ, Liggins GC (1983) Fetal survival after prednisone suppression of maternal lupus-anticoagulant. Lancet 1: 1361–1363PubMedCrossRefGoogle Scholar
  44. 44.
    Lübbe WF, Liggins GC (1985) Lupus anticoagulant and pregnancy. Am J Obstet Gynecol 153: 322–327PubMedGoogle Scholar
  45. 45.
    Branch DW, Scott JR, Kochenour NK, Hershgold E (1985) Obstetric complications associated with the lupus anticoagulant. N Engl J Med 313: 1322–1326PubMedCrossRefGoogle Scholar
  46. 46.
    Lockshin MD, Druzin ML, Qamar T (1989) Prednisone does not prevent recurrent fetal death in women with antiphospholipid antibody. Am J Obstet Gynecol 160: 439–443PubMedGoogle Scholar
  47. 47.
    Rosove MH, Tabsh K, Wasserstrum N, Howard P, Hahn BH, Kalunian KC (1990) Heparin therapy for pregnant women with lupus anticoagulant or anticardiolipin antibodies. Obstet Gynecol 75: 630–634PubMedGoogle Scholar
  48. 48.
    Cowchock FS, Reece A, Balaban D, Branch DW, Plouffe L (1992) Repeated fetal losses associated with antiphospholipid antibodies: a collaborative randomized trial comparing prednisone with low-dose heparin treatment. Am J Obstet Gynecol 166: 1318–1323PubMedGoogle Scholar
  49. 49.
    Carreras LO, Perez GN, Vega RH, Casavilla F (1988) Lupus anticoagulant and recurrent fetal loss: successful treatment with gammaglobulin. Lancet 11: 393–394CrossRefGoogle Scholar
  50. 50.
    Scott JR, Branch DW, Kochenour NK, Ward K (1988) Intravenous immunoglobulin treatment of pregnant patients with recurrent pregnancy loss caused by antiphospholipid antibodies and Rh immunization. Am J Obstet Gynecol 159: 1055–1056PubMedGoogle Scholar
  51. 51.
    Leung W-H, Wong K-L, Lau C-P, Wong C-K, Liu H-W (1990) Association between antiphospholipid antibodies and cardiac abnormalities in patients with systemic lupus erythematosus. Am J Med 89: 411–419PubMedCrossRefGoogle Scholar
  52. 52.
    Nihoyannopoulos P, Gomez PM, Joshi J, Loizou S, Walport M J, Oakley CM (1990) Cardiac abnormalities in systemic lupus erythematosus. Association with raised anticardiolipin antibodies. Circulation 82: 369–375PubMedCrossRefGoogle Scholar
  53. 53.
    Khamashta MA, Cervera R, Asherson RA et al (1990) Association of antibodies against phospholipids with heart valve disease in systemic lupus erythematosus. Lancet 335: 1541–1544PubMedCrossRefGoogle Scholar
  54. 54.
    Galve E, Ordi J, Barquinero J, Evangelista A, Vilardell M, Soler-Soler J (1992) Valvular heart disease in the primary antiphospholipid syndrome. Ann Intern Med 116: 293–298PubMedGoogle Scholar
  55. 55.
    Chartash EK, Lans DM, Paget SA, Qamar T, Lockshin MD (1989) Aortic insufficiency and mitral regurgitation in patients with systemic lupus erythematosus and the antiphospholipid syndrome. Am J Med 86: 407–412PubMedCrossRefGoogle Scholar
  56. 56.
    Pope JM, Canny CLB, Bell DA (1991) Cerebral ischemic events associated with endocarditis, retinal vascular disease, and lupus anticoagulant. Am J Med 90: 299–309PubMedGoogle Scholar
  57. 57.
    O’Rourke RA (1990) Antiphospholipid antibodies. A marker of lupus carditis? Circulation 82: 636–638PubMedCrossRefGoogle Scholar
  58. 58.
    Heyman MR, Flores RH, Edelman BB, Carliner NH (1988) Procainamide-induced lupus anticoagulant. South Med J 81: 934–936PubMedCrossRefGoogle Scholar
  59. 59.
    Li GC, Greenberg CS, Currie MS (1988) Procainamide-induced lupus anticoagulants and thrombosis. South Med J 81: 262–264PubMedCrossRefGoogle Scholar
  60. 60.
    List AF, Doll DC (1989) Thrombosis associated with procainamide-induced lupus anti-coagulant. Acta Haematol 82: 50–52PubMedCrossRefGoogle Scholar
  61. 61.
    Asherson RA, Zulman J, Hughes GRV (1989) Pulmonary thromboembolism associated with procainamide induced lupus syndrome and anticardiolipin antibodies. Ann Rheum Dis 48: 232–235PubMedCrossRefGoogle Scholar
  62. 62.
    Bell WR, Boss GR, Wolfson JS (1977) Circulating anticoagulant in the procainamide-induced lupus syndrome. Arch Intern Med 137: 1471–1473PubMedCrossRefGoogle Scholar
  63. 63.
    Edwards RL, Rick ME, Wakem CJ (1981) Studies on a circulating anticoagulant in procainamide-induced lupus erythematosus. Arch Intern Med 141: 1688–1690PubMedCrossRefGoogle Scholar
  64. 64.
    Lillicrap DP, Pinto M, Benford K, Ford PM, Ford S (1990) Heterogeneity of laboratory test results for antiphospholipid antibodies in patients treated with chlorpromazine and other phenothiazines. Am J Clin Pathol 93: 771–775PubMedGoogle Scholar
  65. 65.
    Canoso RT, Sise HS (1982) Chlorpromazine-induced lupus anticoagulant and associated immunologic abnormalities. Am J Hematol 13: 121–129PubMedCrossRefGoogle Scholar
  66. 66.
    Canoso RT, de Oliveira RM (1988) Chlorpromazine-induced anticardiolipin antibodies and lupus anticoagulant: absence of thrombosis. Am J Hematol 27: 272–275PubMedCrossRefGoogle Scholar
  67. 67.
    Sehleider MA, Nachman RL, Jaffe EA, Coleman M (1976) A clinical study of the lupus anticoagulant. Blood 48: 499–509Google Scholar
  68. 68.
    Mackworth-Young CG, Harris EN, Steere AC et al (1988) Anticardiolipin antibodies in Lyme disease. Arthritis Rheum 31: 1052–1056PubMedCrossRefGoogle Scholar
  69. 69.
    Vaarala O, Palosuo T, Kleemola M, Aho K (1986) Anticardiolipin response in acute infections. Clin Immunol Immunopathol 41: 8–15PubMedCrossRefGoogle Scholar
  70. 70.
    Bloom EJ, Abrams DI, Rodgers G (1986) Lupus anticoagulant in the acquired immuno-deficiency syndrome. JAMA 256: 491–493PubMedCrossRefGoogle Scholar
  71. 71.
    Cohen A J, Philips TM, Kessler CM (1986) Circulating coagulation inhibitors in the acquired immunodeficiency syndrome. Ann Intern Med 104: 175–180PubMedGoogle Scholar
  72. 72.
    Canoso RT, Zon LI, Groopman JE (1987) Anticardiolipin antibodies associated with HTLV-III infection. Br J Haematol 65: 495–498PubMedCrossRefGoogle Scholar
  73. 73.
    Hassel K, Kressin D, Iliff M, Ellison R, Marlar RA (1991) Relationship of lupus anticoagulant and C4b binding protein to free protein S levels in HIV infection. Blood 78: 219a (abstract)Google Scholar
  74. 74.
    Stahl CP, Wideman C, Spira TJ et al (1993) Protein S deficiency in men with long-term human immunodeficiency virus infection. Blood 81: 1801–1807PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1994

Authors and Affiliations

  • B. Alving

There are no affiliations available

Personalised recommendations