The major clinical features of the anti-phospholipid antibody syndrome include:

  1. Recurrent thrombotic events including venous thromboses, cerebrovascular thromboses, myocardial infarctions in patients without significant risk factors. Unusual sites of thromboses such as renal vein, hepatic vein, axillary vein as well as renal artery, mesenteric artery and digital artery may be a reason to suspect the presence of this syndrome even in a patient with a single coagulation event. As a general rule, patients tend to have their recurrent thrombi in either the venous or the arterial circulation but not in both sides of the vascular tree.
  2. Recurrent spontaneous abortions occurring in the first and second trimester. These abortions are believed to be due to placental insufficiency, probably mediated through micro thrombi in the placenta.
  3. Focal central neurological lesions including optic neuritis, transverse myelitis and organic brain syndrome. These features of the anti-phospholipid antibody syndrome do not appear to be mediated by thrombi and may represent direct end organ damage mediated by the anti-phospholipid antibodies or some other autoantibody linked in some fashion to the production of anti-phospholipid antibodies.
  4. Chronic thrombocytopenia has been frequently seen in these patients. In most of the patients the platelet counts have been moderately depressed but severe and clinically important thrombocytopenia has been encountered especially in those patients who have lupus.
  5. Livedo reticularis is a very common feature of the disease and is probably mediated by thrombi in the deep dermal arterioles. While of no significance clinically, this feature is so characteristic of this syndrome that it should alert the physician to look for other features of the syndrome.

Treatment

Warfarin + low dose aspirin