Document Detail


Primary anti-phospholipid antibody syndrome (APS): current concepts.
MedLine Citation:
PMID:  12052409     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Primary anti-phospholipid syndrome (APS) is a thrombophilic state characterized by recurrent arterial and venous thrombosis, recurrent pregnancy loss, and the presence of circulating anti-phospholipid antibodies that may be responsible for thrombophilia and pregnancy morbidity. Ophthalmologic features are present in 15-88% of the patients with primary APS, thus ophthalmologists are one of the first physicians to whom the patient will present. An accurate diagnosis may save the patient from recurrent, potentially life-threatening thrombosis. In the U.S.A., an estimated 35,000 new cases of APS-related venous thrombosis occur each year in a population that is several decades younger than the patient population typically affected by thrombosis. Clinical features, such as chorea, transverse myelitis, cardiac valvular lesions, and accelerated atherosclerosis, are hypothesized to be due to a direct tissue-antibody interaction and cannot be explained purely by thrombosis. The use of recently proposed, well-defined diagnostic criteria, and better standardization of laboratory assays for the anti-phospholipid antibodies should help enable epidemiological surveys to establish the prevalence of these antibodies in patients with thrombosis and in the general population. Diagnosis of APS should be considered in all patients with recurrent systemic or ocular thrombosis in the absence of known risk factors. Several well-designed prospective studies show an increased risk of thrombosis in the presence of medium to high antibody level. With ocular involvement in as many as 88% of APS patients, an ophthalmic assessment should be an integral part of the clinical work-up of any patient with suspected or confirmed APS. The presence of isolated ocular thrombophilia with persistently elevated anti-phospholipid antibodies or lupus coagulant should confirm the diagnosis of APS. Management of these patients must be a multi-disciplinary effort with either a rheumatologist or a hematologist having the overall responsibility for coordinating treatment and monitoring the patient's immune status and anticoagulation. Treatment of isolated ocular thrombophilia in the presence of moderate to high titers of antiphospholipid antibodies should be on the same principles as patients with APS to prevent recurrent ocular or cerebral thrombosis.
Authors:
Omar M Durrani; Caroline Gordon; Philip I Murray
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Survey of ophthalmology     Volume:  47     ISSN:  0039-6257     ISO Abbreviation:  Surv Ophthalmol     Publication Date:    2002 May-Jun
Date Detail:
Created Date:  2002-06-07     Completed Date:  2002-08-05     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0404551     Medline TA:  Surv Ophthalmol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  215-38     Citation Subset:  IM    
Affiliation:
Academic Unit of Ophthalmology, University of Birmingham, Birmingham, United Kingdom.
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MeSH Terms
Descriptor/Qualifier:
Antiphospholipid Syndrome* / complications,  diagnosis,  epidemiology,  therapy
Eye Diseases / diagnosis,  epidemiology,  etiology,  therapy
Humans

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