How antibodies cause thrombosis
Antiphospholipid antibodies bind to proteins on the surface of vascular wall cells, platelets and placental cells. This activates the coagulation system, increases platelet aggregation, and inhibits natural mechanisms that dissolve clots. As a result, a blood clot can form in any vessel - in the deep veins of the legs, in the pulmonary artery, in the vessels of the brain, eyes, kidneys. Blood flow in the placenta is disrupted, and the pregnancy is interrupted or develops with complications. The syndrome can be primary or accompany systemic lupus erythematosus and other autoimmune diseases.
- Primary syndrome without other autoimmune disease
- Secondary to systemic lupus erythematosus
- Venous thrombosis
- Arterial thrombosis, including stroke
- Obstetric complications
- Rare catastrophic form involving multiple organs
When to be suspicious
Investigation is considered if the thrombosis develops in a young person without obvious precipitating factors, recurs, occurs in an unusual location - for example, in the veins of the abdominal cavity or the vessels of the eye - or is combined with a low platelet count. The second big reason is obstetric history: three or more early pregnancy losses, death of a normally developing fetus after the tenth week, premature birth due to severe preeclampsia or placental insufficiency. Sometimes the impetus for examination is the accidentally detected prolongation of coagulation parameters in the analysis.
- Thrombosis at a young age without a reason
- Repeated thromboses
- Thrombosis of unusual localization
- Three or more previous miscarriages
- Fetal death after 10 weeks
- Severe preeclampsia and fetal growth restriction
- Low platelets, livedo reticularis on the skin
What tests are needed
Three indicators are determined: lupus anticoagulant, antibodies to cardiolipin and antibodies to beta-2-glycoprotein, classes IgG and IgM. A mandatory condition is to repeat the study no earlier than twelve weeks later, because a transient increase occurs with infections, tumors and taking a number of drugs, and such a result has nothing to do with the syndrome. The test for lupus anticoagulant cannot be performed correctly while taking anticoagulants, so the time of testing must be agreed with the doctor. Additionally, a complete blood count, coagulogram, renal function and antinuclear antibodies are assessed.
- Lupus anticoagulant
- Antibodies to cardiolipin IgG and IgM
- Antibodies to beta-2-glycoprotein I
- Reconfirmation after 12 weeks
- Complete blood count with platelets
- Extended coagulogram
- Antinuclear antibodies, kidney function
Treatment and prevention of thrombosis
Tactics depend on whether there have already been thromboses. After thrombosis, long-term, often lifelong anticoagulant therapy is prescribed under the control of laboratory parameters; Direct oral medications for this syndrome are not suitable for everyone; the decision is made by the doctor. People with positive antibodies, but without thrombosis, are usually not prescribed treatment, but manageable risk factors are aggressively eliminated. It is important to avoid smoking and estrogen-containing contraceptives, monitor blood pressure, weight and cholesterol, and discuss prevention with your doctor before operations and long flights.
- Long-term anticoagulant therapy after thrombosis
- Monitoring laboratory coagulation parameters
- Quitting smoking
- Avoidance of estrogen-containing contraceptives
- Control of blood pressure, weight and lipids
- Prevention during operations and long-term immobility
- Be careful with any new drugs and dietary supplements
Pregnancy with this diagnosis
Pregnancy is possible and in most cases ends in the birth of a healthy child, but it is planned in advance and managed jointly by an obstetrician-gynecologist and a rheumatologist or hematologist. The standard approach involves low-dose acetylsalicylic acid and low-molecular-weight heparin as determined by the physician; drugs from the group of indirect anticoagulants are not used during pregnancy. More frequent visits, monitoring of fetal growth and blood flow, and monitoring of blood pressure and protein in the urine are required. Prevention continues for several weeks after birth, when the risk of thrombosis is especially high.
- Planning pregnancy with doctors
- Low doses of acetylsalicylic acid
- Low molecular weight heparin as prescribed
- Avoidance of indirect anticoagulants during pregnancy
- Frequent monitoring of fetal growth and blood flow
- Monitoring blood pressure and protein in urine
- Continuation of prophylaxis after childbirth
