Clinical features

Due to the diversity of the condition antiphospholipid syndrome (APS) may affect all organ systems of the body.

The clinical features are presented according to the systems affected:

• thrombosis
  • venous thrombosis and associated complications
    • is more common than arterial thrombosis
    • in a cohort of 1000 patients, 32% presented with deep vein thrombosis in the leg as the initial symptom while in 14%, pulmonary embolism was the first symptom
    • renal, hepatic, subclavian and retinal veins; cerebral sinuses and vena cava are also at a higher risk for thrombotic events when compared to thrombosis not related antiphospholipid syndrome
  • arterial thrombosis
    • most common initial clinical manifestations are stroke (in 13%) and transient ischemic attack (in 7%)
  • recurrent thrombosis
• cerebral involvement
  • is common and include - cerebral ischemia, migraine, cognitive dysfunction, seizures, chorea, psychosis, depression, Guillain-Barre syndrome
  • a link between valvular heart disease and CNS manifestations of the syndrome has been reported
• cardiac manifestations
  • non bacterial thrombotic endocarditis
  • myocardial infarction
• renal manifestations
  • due to thrombosis of the renal vasculature, rapid decline of the renal function can occur
• haematological manifestation
  • thrombocytopaenia
  • haemolytic anaemia
  • dermal symptoms e.g. - lividoreticularis
• maternal and fetal effects
  • recurrent early miscarriages
  • intrauterine fetal death
  • early or severe pre-eclampsia (or both)
  • intrauterine growth restriction (1)
• endocrine
• dermatological

Reference:

• (1) Cohen D et al. Diagnosis and management of the antiphospholipid syndrome. BMJ. 2010;340:c2541