Every autumn, VTE Dublin is held to discuss treatment, care, and research centered around venous thromboembolism (VTE). The conference consists of clinicians and experts who are passionate about improving the standard of care in Ireland and beyond. Additionally, VTE Dublin offers a podcast series centered around talks from the conference. This week, we’ll be telling you all about podcast episode #48, where Amgen’s Karen Breen discusses the diagnosis and management of antiphospholipid syndrome (APS).

The Podcast

During the podcast, Karen Breen discusses the intricacies and complexities of APS diagnosis and management. She begins by explaining the APS is an acquired autoimmune disorder which is often associated with pregnancy-related comorbidities. The condition may be primary or secondary to other autoimmune conditions. As an example, up to 30% of patients with APS also have lupus.

The diagnostic criteria for APS first emerged as the Sydney criteria in the 1990s. However, since being updated in 2006, the criteria are known as the Sapporo criteria. Interested in learning more about these criteria? Click here.

Additional Podcast Information

Additional insights from the podcast include:

• Patients with APS often present with mitral valve abnormalities or livedo reticularis, a particular form of a red lacy rash. However, some patients present with neurological syndromes, which can be more difficult to manage.
• For females to be diagnosed with APS, some clinical criteria include 3 recurrent miscarriages of less than 12 weeks, a late pregnancy loss, or early onset preeclampsia. Around 14% of patients with early onset preeclampsia have APS antibodies, as do 20% with recurrent pregnancy loss.
• If someone presents with persistent antiphospholipid antibodies, testing must be performed twice (12 weeks apart). As false positives can occur, especially in the face of acute infections, the testing is needed to be sure.
• Epidemiologically, up to 5% of the population may have APS antibodies. At this time, there are really no other predicted biomarkers for antiphospholipid syndrome.
• Antibody testing can be difficult because there are often variations between labs.
• In 2012, the British Society of Hematology said they had no recommendation for aspirin in this set of patients. But new guidelines suggest that patients with high-risk APS should use aspirin.
• Females with previous thrombotic history, who later become pregnant, should not use Warfarin but should use heparin throughout their pregnancy. However, there is no consensus on what dose should be used.
• Prior DBT suggests a higher risk of recurrence, and patients should be placed on lifelong anticoagulants.

Antiphospholipid Syndrome (APS)

Antiphospholipid syndrome (APS) is a rare autoimmune disorder characterized by the immune system mistakenly attacking phospholipids in the blood. Normally, phospholipids play a role in blood clotting. However, when the immune system attacks these proteins, dangerous blood clots can form in the arteries or veins. While the exact cause of APS in unknown, some hypothesize that it can result from medication use, other autoimmune disorders, or infections. APS affects females up to 5x as much as males. Most commonly, this disorder is diagnosed between ages 30-40.

Some signs and symptoms linked to APS include:

• Abnormal bleeding
• Blood clots in the legs
  • Note: Blood clots in the legs may be characterized by pain, redness, and swelling. Additionally, these clots may spread to the lungs, causing a pulmonary embolism.
• Stroke
• Valvular damage
• Ocular difficulties, including retinal detachment, keratitis, or blurred vision
• Pregnancy complications, including premature birth; preeclampsia (high blood pressure), and miscarriages or stillbirths
• Livedo reticularis (a red rash with a lacy pattern)
• Transitory ischemic attack (TIA)
  • Note: A TIA is similar to a stroke, though it only lasts for a few minutes and causes no permanent damage.
• Chronic headaches, which include migraines
• Dementia
• Seizures

Learn more about antiphospholipid syndrome here.