Antiphospholipid Antibodies and Arterial Thrombosis

Abstract

Antiphospholipid antibodies are a relatively heterogeneous mix of immunoglobulins with binding specificities for negatively charged or neutral phospholipids. Currently, the most commonly detected antiphospholipid antibodies include the anticardiolipin antibody, the lupus anticoagulant, and an antibody implicated in false-positive VDRL testing. Recently, a clinical syndrome of vaso-occlusive disorders associated with antiphospholipid antibodies has been identified and may result from immune-mediated disruption of endothelial function. This clinical syndrome encompasses arterial and venous thrombosis, recurrent fetal loss, neurologic dysfunction (eg, migraine, chorea, and encephalopathy), systemic and pulmonary arterial hypertension, and endocardial disease. Although most commonly associated with systemic lupus erythematosus, the antiphospholipid antibody syndrome also has been identified in patients with vaso-occlusive disease without systemic lupus erythematosus. Recently, identification of antiphospholipid antibodies has been facilitated by the development of a more sensitive assay for anticardiolipin antibody. In this article, case histories of three patients with arterial thrombosis and associated anticardiolipin antibodies, including the first associated case of terminal aortic thrombosis, are reviewed and the subject of the antiphospholipid antibody syndrome is discussed.

A Large Ascending Aorta Thrombus in a Patient with Acute Myocardial Infarction—Case Report

“…Non-atherosclerotic aortic thrombi have been linked to either aortic pathology or coagulation disturbances. In this case, the patient was diagnosed with antiphospholipid syndrome, deficit of both C and S protein, with positive MTHFR mutation, which are hypercoagulative states that significantly increase the risk for thrombus development in both venous and arterial territory, though only a few cases are known to be associated with aortic thrombosis [2,3].…”

“…The location of the thrombus is a major decisive factor when choosing the appropriate method of treatment. The presence of a thrombus in the ascending aorta has often led to the surgical approach [3], while endovascular [17] or medical treatments were preferred for thrombi located in the aortic arch and descending and abdominal aorta [18,19]. Furthermore, the hemodynamic stability is also a deciding factor.…”

“…Aortic thrombosis is rendered as the cause of 5% of systemic embolisms [1]; however, an aortic thrombus is rarely encountered and is seldomly diagnosed before embolic complications. The etiology of thoracic aortic thrombosis is usually connected to a previous hematological disorder resulting in a hypercoagulability state [2,3], with other causes including aortic pathologies, such as aneurysm, dissection, or vasculitis. The treatment options for aortic thrombosis are medical, interventional, or the surgical approach.…”

Catastrophic antiphospholipid syndrome presenting with aortic barrage: case report and review of the literature

“…Acute aorto-iliac occlusion is a relatively rare macrovascular thrombotic condition that typically occurs in patients with multiple cardiovascular risk factors. 5 Eleven cases of aortic barrage have been reported in association with aPL so far 6–13 including two unpublished cases (Table 1). The female to male ratio is 1.2:1, with a mean age at onset of 42.5 years, reflecting the epidemiological distribution of APS.…”

Acute adrenal insufficiency due to adrenal hemorrhage complicating colorectal surgery: Report of two cases and correlation with the antiphospholipid antibody syndrome

“…The term antiphospholipid antibody is a generic term used for antibodies that specifically target _2GPI and prothrombin [ 6 ]. These include the anticardiolipin antibodies, the anti-β2-GPI, the lupus anticoagulant and an antibody implicated in false-positive VDRL testing [ 7 ]. The diagnosis of APS is based on both clinical and laboratory criteria (Updated Sapporo or Sydney Criteria) [ 8 ].…”