Antiphospholipid antibodies

Spectrum in order of increasing risk is
asymptomatic individuals with positive antibody tests
women with pregnancy loss alone (1 fetal loss after 10 wks or 3 before 10 wks)
patients with thrombosis
rapidly progressive multisystem vascular occlusion
lab - need 2 titers 6-12 weeks apart, of present LA, ACL AB's, or anti beta 2 glycoprotein 1 . LA is more sensitive than APL testing. You CAN run aPTT or DRVVT on warfarinized sample if diluted 2:1 prior to testing.

Factors increasing the risk are
high titers especially lupus anticoagulant
smoking
use of oral contraceptives
surgery
immobilization
pregnancy
inherited coagulable states

APASS showed relation of ACL's with first ischemic stroke. Study within WARRS trial showed no increased risk of thromboocclusive events in patients with antibodies on coumadin.

Other pearls : venous strokes are more common than arterial strokes, and cardiac emboli also occur. Large and small vessel disease can occur. Chorea is more common in primary APL than secondary APL syndrome ( ie lupus) and is usually bilateral

Associations of secondary APL:  CTD esp SLE