From the Guidelines
Antiphospholipid syndrome (APS) is most likely to cause a cerebrovascular accident (stroke) in young adults, typically under the age of 50, with a significant association between APS and stroke in this age group. The association between Antiphospholipid (APL) antibodies and stroke is strongest for young adults (<50 years of age) [ 1 ].
Key Points
- The prevalence of APL antibodies ranges from 1% to 6.5%, with a higher prevalence in the elderly and patients with lupus [ 1 ].
- The Antiphospholipid Antibodies in Stroke Study (APASS) found that 9.7% of ischemic stroke patients and 4.3% of controls had demonstrable anticardiolipin antibodies [ 1 ].
- Multiple studies have shown high recurrence rates in patients with APL antibodies in the young, highlighting the need for effective management and prevention strategies [ 1 ].
Management and Prevention
- Management of APS typically involves lifelong anticoagulation, usually with warfarin, to prevent recurrent thrombotic events [ 1 ].
- The target INR for warfarin therapy in APS patients is typically between 2.0-3.0, although some high-risk cases may require a higher INR target [ 1 ].
- Additional preventive measures include controlling other cardiovascular risk factors and possibly adding low-dose aspirin to the anticoagulation regimen in certain high-risk patients [ 1 ].
From the Research
Antiphospholipid Syndrome (APS) and Cerebrovascular Accident (Stroke)
- APS is a prothrombotic autoimmune disease that is a well-established cause of acute ischemic stroke (AIS) and transient ischemic attack (TIA), particularly in younger patients 2.
- The incidence of APS in young patients with ischemic stroke is 12.5% 3.
- Antiphospholipid antibodies are an independent risk factor for stroke in young adults 4.
- The most common sites of thrombosis in APS are cerebral arteries and deep veins of the lower limbs 5.
- APS may be associated with vasculopathy and arterial dissection, which can lead to ischemic stroke 6.
Age and APS-Related Stroke
- APS-related stroke can occur at any age, but it is more common in younger patients 2, 3, 4.
- The mean age of patients with APS-related stroke is not specified in the studies, but it is mentioned that APS is a major risk factor for stroke in young patients 6.
- One study found that the incidence of young stroke patients under 50 years was 5.2% 3.
Risk Factors and Associations
- Antiphospholipid antibodies, particularly Lupus Anticoagulant, are an independent risk factor for first and possibly recurrent ischemic stroke in young adults 4.
- APS is associated with an increased risk of recurrent thrombotic events, and the presence of antiphospholipid antibodies is a risk factor for stroke, especially in patients with systemic lupus erythematosus (SLE) 3, 5.
- Arterial dissection is a possible cause of ischemic stroke in APS patients, and further research is needed to explore this association 6.