Lupus Anticoagulant-Anticardiolipin-Antiphospholipid Antibody Syndrome

The presence of antibodies to phospholipids and a variety of clinical symptoms, including vascular thromboses, thrombocytopenia, and recurrent pregnancy loss, characterize the lupus anticoagulant-anticardiolipin-antiphospholipid antibody syndrome. Many of these patients have SLE-like symptoms but do not meet specific diagnostic criteria for that disease. The lupus anticoagulant and anticardiolipin antibody may occur in these patients, and both may cause arterial and venous thromboses. Detection of these antiphospholipid antibodies may require a combination of laboratory tests. The lupus anticoagulant will prolong both the partial thromboplastin time (PTT) and the Russell viper venom time. The latter is a more sensitive predictor of disease. Such patients should also be screened for the presence of the factor V Leiden mutation. Anticardiolipin antibody may be detected with ELISA testing. Either antibody may cause false-positive serologic tests for syphilis.

This syndrome may require treatment with anticoagulant medications. In a small number of patients with recurrent pregnancy loss and a diagnosis of lupus anticoagulant syndrome, improved outcomes have been reported following treatment with heparin anticoagulation (8000-20,000 units in two or three doses daily) or low-molecular-weight heparin (1 mg/kg twice daily) and low-dose aspirin begun before or early in pregnancy and continued until the postpartum period. The addition of monthly infusions of IGIV to this regimen did not improve outcomes in such patients.

Levine JS et al: The antiphospholipid syndrome. N Engl J Med 2002;346:752.

Tincani A et al: Treatment of pregnant patients with antiphospholipid syndrome. Lupus 2003;12:524.