Antiphospholipid syndrome refers to the attack the immune system makes on the normal proteins in your blood, causing blood clots in your arteries or veins to form. Moreover, it can cause complications during pregnancy, such as miscarriage and stillbirth.
Blood clots in your leg veins cause a condition known as deep vein thrombosis (DVT) to form, resulting in damage from blood clots in your organs, depending on where the DVT is and how severe it is. Examples of organs affected by this include the kidneys, lungs or brain, depends on the extent and location of the clot. For instance, a clot in your brain can cause a stroke.
Some medications can reduce your risk of blood clots, however there is no cure for antiphospholipid syndrome.
What causes ANTIPHOSPHOLIPID SYNDROME?
In antiphospholipid syndrome, abnormal blood clotting takes place because your body mistakenly produces antibodies that attack a type of fat – called phospholipids – that plays a pivotal role in the clotting process. Antibodies are proteins that normally protect the body against invaders, such as viruses and bacteria.
You can have antiphospholipid antibodies present in your body, however you’ll only be diagnosed with the syndrome if they cause you health problems. Autoimmune disorders, infection or certain medications can be the cause of Antiphospholipid syndrome, or you can develop the syndrome without an underlying cause.
What are the complications for Antiphospholipid Syndrome?
Untreated antiphospholipid syndrome can lead to permanent organ damage or death depending on the organ(s) affected by the blood clot and how severe the flow of blood to that organ is being affected. Complications include:
- Kidney failure: This can result from decreased blood flow to your kidneys.
- Stroke: Result in permanent neurological damage, such as partial paralysis and loss of speech (aphasia) can occur when there is decreased blood flow to the brain.
- Cardiovascular problems: A blood clot in your leg can damage the valves in the veins, stopping the flow of blood to your heart, resulting in chronic swelling and discoloration of your lower legs (chronic venous insufficiency). Heart damage can also occur.
- Lung problems: Pulmonary hypertension (high blood pressure in your lungs) and pulmonary embolism can occur.
- Pregnancy complications: Miscarriages, stillbirths, slow fetal growth, premature delivery and high blood pressure during pregnancy (preeclampsia) can occur.
Rarely, a person can have repeated clotting events within a short time frame, leading to progressive damage in multiple organs (catastrophic antiphospholipid syndrome).
WHAT ARE THE SYMPTOMS OF Antiphospholipid Syndrome?
Signs and symptoms of antiphospholipid syndrome can include:
- Blood clots in your legs (DVT): These clots can travel to your lungs. This is know as a pulmonary embolism.
- Repeated miscarriages or stillbirths: High blood pressure during pregnancy (preeclampsia) and other complications such as premature miscarriage and stillbirths can occur.
- Stroke: A young person who has antiphospholipid syndrome but no known risk factors of cardiovascular diseases is capable of having a stroke.
- Transitory ischemic attack (TIA): TIA is similar to a stroke but usually lasts only a few minutes and causes no permanent damage.
- Rash: Some people develop livedo reticularis, a red rash with a lacy, net-like pattern.
Less common signs and symptoms include:
- Neurological symptoms: When a blood clot blocks blood flow to parts of your brain chronic headaches, including migraines; dementia and seizures are possible.
- Cardiovascular disease: Antiphospholipid syndrome can lead to damage in the heart valves.
- Bleeding: Decreased numbers of platelets – blood cells needed for clotting – also occurs in some people) resulting in few or no symptoms. This is known as thrombocytopenia.
If your platelet count drops too low however, you may experience episodes of bleeding, particularly from the nose and gums. You can also bleed into your skin, which appear as patches of small red spots (petechiae).
TREATMENT OPTIONS AVAILABLE FOR Antiphospholipid Syndrome
Antiphospholipid syndrome is usually treated using medications that reduce your body’s ability to clot, resulting in less complications occurring.
Standard initial treatment
Standard initial treatment of thrombosis involves a combination of blood-thinning (anticoagulant) medications including:
- Heparin: An injection of the blood thinner heparin will typically be given first along with another blood thinner in pill form, likely warfarin (Coumadin, Jantoven).
- Warfarin: After several days of combined heparin and warfarin, your doctor may choose to discontinue the heparin and instead, continue with the warfarin, possibly for the rest of your life.
- Aspirin: In some cases, a low-dose aspirin will be added to the treatment plan.
There is an increased risk of bleeding episodes when you’re taking anticoagulant medication, therefore your doctor will monitor your dosage with blood tests to be sure your blood is capable of clotting just enough to stop the bleeding caused by a cut or the bleeding under the skin from a bruise.
Treatment during pregnancy
Preventing your blood from clotting increases your chances of carrying to term. Treatment options include:
- Heparin: Enoxaparin (Lovenox) and dalteparin (Fragmin are known as low-molecular-weight forms of heparin, and can be injected yourself under your skin (subcutaneously). Heparin is considered safe to take during pregnancy.
- Aspirin: Your doctor might recommend taking one tablet of aspirin daily in addition to the heparin if you’re pregnant. This will increase your chances of a successful pregnancy.
Possible future treatments
Three a several new treatments being considered for antiphospholipid syndrome treatment, including:
- New blood thinners (anticoagulants): Oral blood thinners such as dabigatran (Pradaxa), rivaroxaban (Xarelto) and apixaban (Eliquis), have recently been approved for the treatment other conditions, it’s not yet clear whether these drugs are appropriate for treating antiphospholipid syndrome. Use of these drugs is not recommended during pregnancy or breast-feeding.
- Rituximab (Rituxan): This drug has been successfully used to treat conditions affecting the immune system, there is insufficient evidence that rituximab is a suitable option for the treatment of antiphospholipid syndrome.
HOW IS antiphospholipid syndrome BEING DIAGNOSED?
Testing the blood of patients with blood clots and/or recurrent miscarriages for the presence of anti-phospholipid autoantibodies (aPL) is important when testing for antiphospholipid syndrome. Screening is done using three kinds of tests that can vary depending on the differences in the aPL from patient to patient.
Each test alone, cannot detect all of the possible autoantibodies, so combining these tests is strongly advised. At least one of these tests must be positive, and be confirmed on two occasions no less than three months apart in order for diagnosis to be confirmed. The general rule is, the higher the level of the test and the greater number of positive tests, the higher the risk there is of developing symptoms.
Having positive blood tests alone in the absence of a clot does not diagnose antiphospholipid syndrome. There are many healthy people who carry these clotting proteins in their blood who never experience a clot in their whole life.