The Importance of Early Diagnosis and Treatment of Antiphospholipid Syndrome

The Importance of Early Diagnosis and Treatment of Antiphospholipid Syndrome

Introduction

This clinical article focuses on Antiphospholipid Syndrome (APS) and how early diagnosis can increase treatment options.

What is APS?

Antiphospholipid syndrome (APS), also known as Hughes Syndrome is an autoimmune disorder regarding the formation of antibodies that have the ability to enhance the potential of coagulation (clotting). The antibodies are generally directed to phospholipids which are found in the plasma, on the surface of endothelial cells (blood vessel lining) and on platelets.

There are two types of APS:

Primary antiphospholipid syndrome – this is not linked to any other disease and develops in isolation.

Secondary antiphospholipid syndrome – this develops along with another autoimmune disorder, for example lupus.

Some people with APS do not always have symptoms, however, others can experience headaches, fatigue, balance and memory difficulties and joint pain.

In order to diagnose APS a series of blood tests can be undertaken, that will test the abnormality of the Antiphospholipid antibodies. These tests are the anticardiolipin test, the anti-beta-glycoprotein 1 test and the lupus anticoagulant test. The diagnosis of APS is made, if on at least two occasions, the blood tests are positive for aPL and at least 12 weeks apart.

A patient who is diagnosed with APS should then be referred to a specialist for appropriate treatment.

Independent Recommendations to Improve Healthcare Standards and Patient Safety

Clinicians should bear in mind the importance of diagnosing APS early.

The standard treatment options for APS consists of prescribing anticoagulant medication, such as warfarin, or an antiplatelet medication such as aspirin which thins the blood. This treats APS by interrupting the process of unnecessary blood clot formation.

Patients with APS will most likely be required to take anticoagulant or antiplatelet medication daily for the rest of their lives, in order to control the formation of blood clots, however, if a blood clot does form and the symptoms are severe – in these instances, injections of an anticoagulant called heparin can be given which will act faster to help resolve the issue.

Catastrophic antiphospholipid syndrome (CAPS) is a rare but serious complication of antiphospholipid syndrome (APS) which can cause blood clots throughout the body which can then result in multiple organ failure. It occurs in less than 1% of people with APS.

APS can be difficult to manage and often requires considerable expertise. Therefore, early diagnosis and treatment is important to prevent miscarriages, stroke, heart attack and future thromboses such as PE and DVT.

In order to diagnose APS sooner, awareness needs to be raised amongst the medical profession and public, to ensure that if there is any suspicion, then appropriate tests are carried out to rule out this possible diagnosis. Additionally, further research is required to better understand the causes and treatments for APS.

References

  • Co-written by The TMLEP Clinical Risk and Patient Safety Publishing Group and Ms Zoe Newark, TMLEP Analyst. (2021). The Importance of early Diagnoses and Treatment of Antiphospholipid Syndrome. TMLEP Clinical Risk Case Studies. 7 (8), 1.

Important Note

This article is intended to raise awareness to clinical risk issues in an effort to reduce incidence recurrence and improve patient safety. This is not intended to be relied upon as advice. Facts have been altered to ensure this case is non-identifiable, albeit clinical learning points remain applicable. To request an independent clinical review, please contact admin@tmlep.com or call +44 (0) 203 355 9796.