I. Diagnosis
II. Management
GLOSSARY
anticoagulation to decrease the tendency of the blood to form a
clot, thrombosis. lupus short for systemic lupus erythematosus (SLE). platelets very small disk-like particles that circulate in the blood
alongside red and white blood cells initiating the formation of
blood clots; platelets clump and form little plugs, thus causing
bleeding to stop. thrombocytopenia a mild decrease in platelet counts.

The principal autoantigen of antiphospholipid antibody syndrome has been shown to be beta-2-glycoprotein 1 (apolipoprotein H), a protein that binds cardiolipin and exposes an antigenic epitope. The antibody is called cardiolipin, lupus anticoagulant, or anti-beta-2 glyco-protein 1 depending on the test used. Two inexpensive tests, a standardized enzyme-linked immunosorbent assay for anticardiolipin antibodies and a clotting test for lupus anticoagulant, rapidly rule out antiphospholipid syndrome.
The antiphospholipid syndrome and factor V Leiden are the most common causes of thrombophilia accounting for greater than 20% of cases of recurrent thrombosis in individuals under age 40. Approximately 15% of women with recurrent pregnancy loss have this syndrome.

• I. DIAGNOSIS
  This complex syndrome actually is described as primary (not associated with another illness) and secondary (asso¬ciated with SLE or another rheumatic disease). The anti-phospholipid antibody (APLA) is detected in more than one-third of patients with lupus.
• II. MANAGEMENT
  Thrombosis of veins or arteries should be treated with full-dose oral anticoagulation with warfarin. A Canadian study indicated that using warfarin to keep the target INR at 2–3 provides beneficial results that are equal to that observed with high-dose anticoagulation with an International Normalize Ratio (INR) of 3.1–4.0. A retrospective study in women in whom antiphospholipid antibody syndrome was diagnosed because of pregnancy loss (none of whom had a previous thrombotic event) suggests that treatment with low-dose aspirin provides protection from thrombosis. An ongoing clinical trial in the United States is comparing aspirin with placebo and a study in the UK is comparing aspirin with low-dose warfarin plus aspirin.
• BIBLIOGRAPHY
  

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