<p>Intracardiac thrombus in a patient with catastrophic antiphospholipid syndrome: an autopsy case report and review of the literature</p>

Abstract

Antiphospholipid syndrome (APS) is an autoantibody-mediated acquired thrombophilia characterized by venous and/or arterial thromboses, pregnancy morbidity (predominantly repeated fetal losses), and the presence of phospholipid antibodies. The estimated annual incidence of APS is 5 new cases per 100,000 people. The most common thrombotic events in patients with APS in order of frequency are stroke, transient ischemic attack, deep vein thrombosis, and pulmonary embolism. Patients with APS may develop an intracardiac thrombus, which is a life-threatening complication with a high risk of increased morbidity and mortality; however, it is treatable by surgical removal, extensive anticoagulant administration, and prevention of other complications. Catastrophic APS, which is a rare and severe condition diagnosed based on rapidly progressive thromboembolic events involving three or more organs, systems, or tissues, occurs in less than 1% of all patients with APS. We herein report an autopsy case of catastrophic APS in a 12-year-old Thai boy with multiple thromboembolic events including intracardiac thrombus formation with a positive lupus anticoagulant test result. To the best of our knowledge, this is the youngest reported patient with APS to date.

Histopathological findings in the advanced natural evolution of the SARS-CoV-2 infection

“…On the one hand, it is suggested that antiphospholipid antibodies act under several conditions to promote thrombus formation, such as antibodies having various roles, such as in promoting platelet aggregation, binding to platelet membrane proteins, inhibiting fibrinolysis and anticoagulant activity, promoting inflammation; binding to beta 2 glycoprotein I (β2GPI) expressed on the surface of endothelial cells, and causing the cells to turn into a procoagulant and proinflammatory phenotype. However, all these conditions are not sufficient to promote thrombosis, and a second condition is required, respectively the endothelial lesion that may be the direct result of the SARS-CoV-2 infection [31].…”

Development of intracardiac thrombus in a young patient with antiphospholipid syndrome while she was on rivaroxaban: Case report and literature review

“…One of these patients was a female teenager who had APS associated with systemic lupus erythematosus. 15 In APS patients with intracardiac thrombosis, adequate maintenance anticoagulation therapy heparin and warfarin (target INR 3.0-4.0) are required. The role of intervention in surgery remains controversial.…”

“…The right atrial chamber was the most frequent location of the intracardiac thrombus; however, thrombus was identified in the left atrium and left ventricle in some cases. One of these patients was a female teenager who had APS associated with systemic lupus erythematosus 15 …”

Infarto agudo de miocardio como manifestación inicial de síndrome antifosfolípido primario: Reporte de Caso

“…Se ha tratado de asociar esta complicación al subtipo del anticuerpo, sin embargo, la evidencia no es concluyente, pues en algunos casos se ha relacionado más con el anticuerpo antibeta 2 glicoproteína I y el anticoagulante lúpico mientras que otros han relacionado los anticuerpos anticardiolipina IgG o IgA, este último en IAM con elevación del ST. Se han reportado casos fatales en pacientes jóvenes, donde las manifestaciones cardiacas ocurren por desórdenes inmunes y por su asociación con fenómenos trombóticos (25)(26)(27)(28)(29)(30).…”