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. 1991 Nov;50(11):805–810. doi: 10.1136/ard.50.11.805

Antiphospholipid syndrome: five year follow up.

R A Asherson 1, E Baguley 1, C Pal 1, G R Hughes 1
PMCID: PMC1004563  PMID: 1772297

Abstract

Nineteen patients out of 250 subjects with antiphospholipid antibodies, who had initially presented to the lupus clinic at St Thomas's Hospital, London five or more years ago with a history of venous/arterial occlusions, were entered into the study. The patients were divided into two main groups: I those who remained well without any further thromboembolic complications (n = 10); II those who developed recurrent thrombotic events in the five year period (n = 9). The patients were followed up to determine the relation between the level or the isotype of the anticardiolipin antibodies, or both, to the recurrent thromboembolic events, and the effect of a variety of treatments (corticosteroids, immunosuppression, anticoagulation) in the prevention of further vascular occlusions. Lupus activity over the five year period varied considerably between the two groups--those in group I tending to be relatively inactive compared with those in group II. For some patients in group II thromboembolic events seemed to occur at the time of lupus activity. Antiphospholipid antibodies remained positive in all patients, the levels remaining fairly constant. Levels fell in only one patient in group I and in two in group II. Patients in group II had more systemic lupus erythematosus related disease than those in group I; most were receiving concomitant steroid and immunosuppressive therapy, but this did not seem to protect against the development of further occlusions. All patients were given anticoagulation treatment (warfarin/heparin) or salicylates (low dose aspirin 75 mg daily), or both. Patients with deep vein thromboses developed more complications during anticoagulation therapy than those with cerebrovascular symptoms. Problems in anticoagulation control and recurrent thromboses consequent on warfarin withdrawal despite the administration of subcutaneous heparin were responsible for complications in most patients in group II.

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Selected References

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  1. Alarcón-Segovia D., Sanchez-Guerrero J. Primary antiphospholipid syndrome. J Rheumatol. 1989 Apr;16(4):482–488. [PubMed] [Google Scholar]
  2. Angles-Cano E., Sultan Y., Clauvel J. P. Predisposing factors to thrombosis in systemic lupus erythematosus: possible relation to endothelial cell damage. J Lab Clin Med. 1979 Aug;94(2):312–323. [PubMed] [Google Scholar]
  3. Asherson R. A., Harris E. N. Anticardiolipin antibodies--clinical associations. Postgrad Med J. 1986 Dec;62(734):1081–1087. doi: 10.1136/pgmj.62.734.1081. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Asherson R. A., Khamashta M. A., Ordi-Ros J., Derksen R. H., Machin S. J., Barquinero J., Outt H. H., Harris E. N., Vilardell-Torres M., Hughes G. R. The "primary" antiphospholipid syndrome: major clinical and serological features. Medicine (Baltimore) 1989 Nov;68(6):366–374. [PubMed] [Google Scholar]
  5. Boey M. L., Colaco C. B., Gharavi A. E., Elkon K. B., Loizou S., Hughes G. R. Thrombosis in systemic lupus erythematosus: striking association with the presence of circulating lupus anticoagulant. Br Med J (Clin Res Ed) 1983 Oct 8;287(6398):1021–1023. doi: 10.1136/bmj.287.6398.1021. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Drenkard C., Sánchez-Guerrero J., Alarcón-Segovia D. Fall in antiphospholipid antibody at time of thromboocclusive episodes in systemic lupus erythematosus. J Rheumatol. 1989 May;16(5):614–617. [PubMed] [Google Scholar]
  7. Elias M., Eldor A. Thromboembolism in patients with the 'lupus'-type circulating anticoagulant. Arch Intern Med. 1984 Mar;144(3):510–515. [PubMed] [Google Scholar]
  8. Exner T. Similar mechanism of various lupus anticoagulants. Thromb Haemost. 1985 Feb 18;53(1):15–18. [PubMed] [Google Scholar]
  9. Gharavi A. E., Harris E. N., Asherson R. A., Hughes G. R. Anticardiolipin antibodies: isotype distribution and phospholipid specificity. Ann Rheum Dis. 1987 Jan;46(1):1–6. doi: 10.1136/ard.46.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Gladman D. D., Urowitz M. B. Venous syndromes and pulmonary embolism in systemic lupus erythematosus. Ann Rheum Dis. 1980 Aug;39(4):340–343. doi: 10.1136/ard.39.4.340. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Harris E. N., Gharavi A. E., Boey M. L., Patel B. M., Mackworth-Young C. G., Loizou S., Hughes G. R. Anticardiolipin antibodies: detection by radioimmunoassay and association with thrombosis in systemic lupus erythematosus. Lancet. 1983 Nov 26;2(8361):1211–1214. doi: 10.1016/s0140-6736(83)91267-9. [DOI] [PubMed] [Google Scholar]
  12. Ishii Y., Nagasawa K., Mayumi T., Niho Y. Clinical importance of persistence of anticardiolipin antibodies in systemic lupus erythematosus. Ann Rheum Dis. 1990 Jun;49(6):387–390. doi: 10.1136/ard.49.6.387. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Kalunian K. C., Peter J. B., Middlekauff H. R., Sayre J., Ando D. G., Mangotich M., Hahn B. H. Clinical significance of a single test for anti-cardiolipin antibodies in patients with systemic lupus erythematosus. Am J Med. 1988 Nov;85(5):602–608. doi: 10.1016/s0002-9343(88)80229-8. [DOI] [PubMed] [Google Scholar]
  14. Kauffmann R. H., Veltkamp J. J., Van Tilburg N. H., Van Es L. A. Acquired antithrombin III deficiency and thrombosis in the nephrotic syndrome. Am J Med. 1978 Oct;65(4):607–613. doi: 10.1016/0002-9343(78)90848-3. [DOI] [PubMed] [Google Scholar]
  15. Kuhlmann U., Steurer J., Rhyner K., von Felten A., Briner J., Siegenthaler W. Platelet aggregation and beta-thromboglobulin levels in nephrotic patients with and without thrombosis. Clin Nephrol. 1981 May;15(5):229–235. [PubMed] [Google Scholar]
  16. Mackworth-Young C. G., Loizou S., Walport M. J. Primary antiphospholipid syndrome: features of patients with raised anticardiolipin antibodies and no other disorder. Ann Rheum Dis. 1989 May;48(5):362–367. doi: 10.1136/ard.48.5.362. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Morrison B. W. Protein S and the nephrotic syndrome. Ann Intern Med. 1988 Jan;108(1):152–152. doi: 10.7326/0003-4819-108-1-152_1. [DOI] [PubMed] [Google Scholar]
  18. Out H. J., de Groot P. G., Hasselaar P., dan Vliet M., Derksen R. H. Fluctuations of anticardiolipin antibody levels in patients with systemic lupus erythematosus: a prospective study. Ann Rheum Dis. 1989 Dec;48(12):1023–1028. doi: 10.1136/ard.48.12.1023. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Peck B., Hoffman G. S., Franck W. A. Thrombophlebitis in systemic lupus erythematosus. JAMA. 1978 Oct 13;240(16):1728–1730. [PubMed] [Google Scholar]
  20. Sturfelt G., Nived O., Norberg R., Thorstensson R., Krook K. Anticardiolipin antibodies in patients with systemic lupus erythematosus. Arthritis Rheum. 1987 Apr;30(4):382–388. doi: 10.1002/art.1780300404. [DOI] [PubMed] [Google Scholar]
  21. Tan E. M., Cohen A. S., Fries J. F., Masi A. T., McShane D. J., Rothfield N. F., Schaller J. G., Talal N., Winchester R. J. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1982 Nov;25(11):1271–1277. doi: 10.1002/art.1780251101. [DOI] [PubMed] [Google Scholar]
  22. Thomson C., Forbes C. D., Prentice C. R., Kennedy A. C. Changes in blood coagulation and fibrinolysis in the nephrotic syndrome. Q J Med. 1974 Jul;43(171):399–407. [PubMed] [Google Scholar]
  23. Vaziri N. D., Branson H. E., Ness R. Changes of coagulation factors IX, VIII, VII, X, and V in nephrotic syndrome. Am J Med Sci. 1980 Nov-Dec;280(3):167–171. doi: 10.1097/00000441-198011000-00005. [DOI] [PubMed] [Google Scholar]
  24. Vigano-D'Angelo S., D'Angelo A., Kaufman C. E., Jr, Sholer C., Esmon C. T., Comp P. C. Protein S deficiency occurs in the nephrotic syndrome. Ann Intern Med. 1987 Jul;107(1):42–47. doi: 10.7326/0003-4819-107-1-42. [DOI] [PubMed] [Google Scholar]

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