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Management of antiphospholipid syndrome
  1. Imad Uthman1,
  2. Mohammad Hassan A Noureldine2,
  3. Guillermo Ruiz-Irastorza3,
  4. Munther Khamashta4
  1. 1 Division of Rheumatology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
  2. 2 Division of Neurosurgery, Lebanese American University Medical Center – Rizk Hospital, Beirut, Lebanon
  3. 3 Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, UPV/EHU, Barakaldo, Spain
  4. 4 Department of Rheumatology, Dubai Hospital, Dubai, United Arab Emirates
  1. Correspondence to Professor Munther Khamashta, Departmentof Rheumatology, Dubai Hospital, Dubai 7272, United Arab Emirates; makhamashta{at}


Antiphospholipid syndrome, also known as ‘Hughes Syndrome’, is an autoimmune disease characterised by a set of clinical manifestations, almost all of which are direct or indirect sequelae of a hypercoagulable state involving the venous, and to a lesser extent the arterial vasculature. The incidence and prevalence of antiphospholipid syndrome are estimated at approximately 5 de novo cases per 100 000 per year and 40–50 cases per 100 000 individuals, respectively. The clinical spectrum of antiphospholipid syndrome involves haematological (thrombocytopaenia, venous thrombosis), obstetrical (recurrent pregnancy loss), neurological (stroke, transient ischaemic attack, migraine, seizures, cognitive dysfunction, chorea, transverse myelitis, multiple sclerosis), cardiovascular (cardiac valve disease), dermatological (livedo reticularis and racemosa, skin ulceration and necrosis), renal (glomerulonephritis, renal thrombotic microangiopathy) and orthopaedic (avascular necrosis of bones, non-traumatic fractures) manifestations, among others. In addition to the classical antiphospholipid antibodies, namely anticardiolipin antibodies and lupus anticoagulant, new autoantibodies and antibody complexes of different immunoglobulin subtypes (IgA, IgG, IgM) are now recognised as significant contributors to the pathogenesis of antiphospholipid syndrome. Anticoagulation remains the cornerstone in the management of antiphospholipid syndrome; nevertheless, new drugs and therapeutic strategies are being tested, and some have been found effective for the primary and secondary thromboprophylaxis in antiphospholipid syndrome.

  • antiphospholipid syndrome
  • antiphospholipid antibodies
  • thromboprophylaxis
  • catastrophic APS
  • obstetric APS

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  • Handling editor Josef S Smolen

  • Contributors IU, MHAN, GR-I, MK: planning, write-up and critical revision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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