Recurrent stroke and thrombo‐occlusive events in the antiphospholipid syndrome

Abstract

We prospectively studied 81 consecutively identified patients with antiphospholipid antibodies (aPLs) who developed focal cerebral ischemia over a 7-year period. The mean age of this cohort was approximately a decade younger than the average atherothromboembolic stroke victim and women were more commonly involved than men. The frequency of conventional stroke risk factors was lowest in the group of stroke patients with the highest levels of IgG cardiolipin immunoreactivity. Other serological abnormalities associated with aPL (false-positive Venereal Disease Research Laboratory test, thrombocytopenia, prolonged activated partial thromboplastin time [aPTT]) were more common in the group with over 100 GPL units (high positive). Patients with the highest IgG anticardiolipin titers had the shortest times to subsequent thrombo-occlusive events. The most common recurrent event was cerebral infarction, often occurring within the first year of follow-up during a mean prospective follow-up of 3 years. Over one-half of the cohort had at least one recurrent thrombo-occlusive event during follow-up. This distinct syndrome of cerebral ischemia should be recognized for its younger age at onset, predominance of women, high risk of recurrent thrombo-occlusive events, and the possible use of the IgG anticardiolipin antibody titer for prognosis.

Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

“…[689][690][691][692][693][694] In a case-control study of 255 patients with a mean age of 66 years, the presence of an anticardiolipin antibody was associated with a significantly increased risk for ischemic stroke (adjusted OR, 2.31; 95% CI, 1.09-4.90). 695 These findings were not replicated in a subsequent prospective cohort study that was part of WARSS.…”

“…700 Other studies that enrolled older patients or a mixture of young and old patients with ischemic stroke indicated wide variability in the prevalence of antiphospholipid antibodies, from 6% to 46%, and inconsistent findings for an association. [690][691][692][693][694][696][697][698][699]701 The wide variability reflects differences in diagnostic criteria, including persistence.…”

Antiphosphatidylserine Antibodies and Clinical Outcomes in Patients With Acute Ischemic Stroke

“…Early studies showed an increased recurrent stroke risk associated with aPLs, 24,25 but later studies that included larger numbers of patients failed to find such an association. 8,26 The Antiphospholipid Antibodies and Stroke Study (n=1770), a prospective cohort study, reported that immunoreactivity to either aCL or lupus anticoagulant antibodies at the time of a first ischemic stroke did not influence the risk of subsequent thrombo-occlusive events over the following 2 years.…”

Avascular necrosis of bone with hemiparesis: a rare presentation of primary antiphospholipid antibody syndrome

“…In consecutive patients with aPLs and focal cerebral ischaemia, cerebral infarctions within the first follow-up year supported the data that IgG aCL represented a risk factor for recurrent stroke. 13 In a later study this was confirmed, and the subsequent thrombo-occlusive events were associated with IgG aCL (most frequently in patients with aCL 40 GPL), thus confirming the role of aCL as a risk factor for recurrent stroke.…”