Exam Cram

• Antiphospholipid Syndrome (APS) is an autoimmune condition that produces antibodies against phospholipids (fat molecules)

• Presentation: recurrent miscarriages, DVTs and arterial clots

• Antibodies: lupus anticoagulant, beta glycoprotein and anti-cardiolipin

• Management: warfarin or LWMH in pregnancy

Outline

Background

Antiphospholipid antibodies target phospholipid binding proteins, resulting in arterial or venous clots. APS can be primary of secondary to Systemic Lupus Erythematous (40%). 

Incidence: 1/ 100,000. 

Assessment

History

• DVT

• Miscarriage

• Range of atypical arterial/ venous clots

Examination

• Livedo reticularis

• High blood pressure

• Cognitive or renal impairment (from clots)

Investigations

• Antibodies: lupus anticoagulant, beta glycoprotein and anti-cardiolipin

• HLA DR4 and DR7 

• Long APTT (don't correct with mixing of normal plasma)

• Thrombocytopenia

Diagnosis

Diagnosis: clinical, based upon:

1. Antibodies- repeated 12 weeks later

• Lupus anti-coagulant

• Beta glycprotein

• Anti-cardiolipin

2. Clinical features

• Clots- VTE or arterial

• Pregnancy loss

Differentials: thrombophilias

Classification: aetiology

• Primary/ idiopathic

• Secondary

  • Systemic Lupus Erythematous 

Management

Acute & long term: warfarin

Pregnancy: LMWH +- aspirin

Med Reg Notes

Long Term Management

Unprovoked DVTs in the context of APS have a high rate of re-occurrence, therefore anticoagulation is usually lifelong. Warfarin (or heparin during pregnancy) is standard. 

Hughes Syndrome

Old name for APS

References and Resources

1. https://www.nhs.uk/conditions/antiphospholipid-syndrome/

Page written in 2025.