Cerebrovascular disease with antiphospholipid antibodies: immune mechanisms, significance, and therapeutic options.
There has been a recent, dramatic surge in interest in antiphospholipid antibodies and associated clinical disorders, especially focal ischemic cerebrovascular disease. Antiphospholipid antibodies are a heterogeneous group of antibodies with varying specificities. Coagulation assays will detect lupus anticoagulants while enzyme-linked immunosorbent assays detect anticardiolipin antibodies. There are numerous potential links between antiphospholipid antibodies and coagulation disorders, including interaction of antiphospholipid antibodies and a cofactor, beta 2-glycoprotein I, which itself is involved in coagulation mechanisms. While the specific mechanism of antiphospholipid antibody-related coagulopathy is unknown, it is clear that antiphospholipid antibodies are associated with an immune-mediated prothrombotic state. Patients with the highest titers of IgG antiphospholipid antibodies have a relatively high risk of recurrent thrombotic events, especially stroke, deep venous thrombosis, and spontaneous abortion. Because of limited controlled, prospective data, current therapy remains empiric and directed at coagulation mechanisms, immune mechanisms, or both.
Feldmann
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Department of Clinical Neurosciences, Brown University School of Medicine, Providence, RI, USA.
Levine
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SR
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000818:Animals; D017152:Antibodies, Antiphospholipid / Q000276:immunology*; D000918:Antibody Specificity; D000925:Anticoagulants / Q000627:therapeutic use; D016736:Antiphospholipid Syndrome / Q000150:complications* / Q000276:immunology / Q000628:therapy; D001324:Autoantigens / Q000276:immunology; D001779:Blood Coagulation Factors / Q000276:immunology / Q000502:physiology; D001792:Blood Platelets / Q000276:immunology / Q000502:physiology; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000276:immunology* / Q000628:therapy; D004730:Endothelium, Vascular / Q000276:immunology / Q000503:physiopathology; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016682:Lupus Coagulation Inhibitor / Q000276:immunology; D008297:Male; D010951:Plasma Exchange; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D013927:Thrombosis / Q000209:etiology / Q000276:immunology
D000305:Adrenal Cortex Hormones; D017152:Antibodies, Antiphospholipid; D000925:Anticoagulants; D001324:Autoantigens; D001779:Blood Coagulation Factors; D005343:Fibrinolytic Agents; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D016682:Lupus Coagulation Inhibitor; D010975:Platelet Aggregation Inhibitors