The antiphospholipid syndrome: what are we really measuring? How do we measure it? And how do we treat it?
The antiphospholipid syndrome is described with a review of its historical development as a recognized syndrome, what constitutes an antiphospholipid antibody, how it is measured, and how the syndrome is treated. Antiphospholipid antibodies are actually antibodies to a protein, most often beta-2-glycoprotein 1, that is usually bound to a phospholipid. Some antibodies are directed towards lipid-bound prothrombin. The antibodies are measured by immunologic assays or by antibody-dependent abnormalities detected in coagulation assays. Although they prolong coagulation assays, they are associated with a thrombotic tendency rather than a bleeding disorder. There are numerous postulated mechanisms to account for the thrombotic tendency. Patients with the antiphospholipid syndrome are treated with long-term oral anticoagulation to prolong the INR to 2.0 to 3.0. For most patients, a more intense level of treatment with a higher INR is not needed.
Division of Hematology, Departments of Medicine and Pathology, Duke University Medical Center, Box 3422, Durham, NC 27710, USA. ortel001@mc.duke.edu
Thomas L
TL
Ortel
D000368:Aged; D017152:Antibodies, Antiphospholipid / Q000276:immunology*; D000925:Anticoagulants / Q000008:administration & dosage; D016736:Antiphospholipid Syndrome / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D017984:Enoxaparin / Q000008:administration & dosage; D005189:False Positive Reactions; D005260:Female; D006023:Glycoproteins / Q000276:immunology; D006801:Humans; D020521:Stroke / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology; D013997:Time Factors; D020246:Venous Thrombosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology; D014859:Warfarin / Q000008:administration & dosage; D053482:beta 2-Glycoprotein I
D017152:Antibodies, Antiphospholipid; D000925:Anticoagulants; D017984:Enoxaparin; D006023:Glycoproteins; D053482:beta 2-Glycoprotein I; D014859:Warfarin