Antiphospholipid antibodies and arterial thrombosis. Case reports and a review of the literature
G. S. McGee, W. H. Pearce, L. Sharma, D. Green and J. S. Yao
Department of Surgery, Northwestern University Medical School, Chicago, IL.
Antiphospholipid antibodies are a relatively heterogeneous mix of
immunoglobulins with binding specificities for negatively charged or
neutral phospholipids. Currently, the most commonly detected
antiphospholipid antibodies include the anticardiolipin antibody, the lupus
anticoagulant, and an antibody implicated in false-positive VDRL testing.
Recently, a clinical syndrome of vaso-occlusive disorders associated with
antiphospholipid antibodies has been identified and may result from
immune-mediated disruption of endothelial function. This clinical syndrome
encompasses arterial and venous thrombosis, recurrent fetal loss,
neurologic dysfunction (eg, migraine, chorea, and encephalopathy), systemic
and pulmonary arterial hypertension, and endocardial disease. Although most
commonly associated with systemic lupus erythematosus, the antiphospholipid
antibody syndrome also has been identified in patients with vaso-occlusive
disease without systemic lupus erythematosus. Recently, identification of
antiphospholipid antibodies has been facilitated by the development of a
more sensitive assay for anticardiolipin antibody. In this article, case
histories of three patients with arterial thrombosis and associated
anticardiolipin antibodies, including the first associated case of terminal
aortic thrombosis, are reviewed and the subject of the antiphospholipid
antibody syndrome is discussed.
