Lupus anticoagulant activity as a thrombosis risk factor in lung adenocarcinoma patients.

There is a high incidence of thrombosis in cancer patients. Retrospective studies indicate that lupus anticoagulant (LA) antibodies can be a thrombosis risk factor in cancer. In 77 patients with different forms of cancer LA and thrombosis incidence were retrospectively evaluated. In a prospective study, with 42 lung adenocarcinoma patients, we measured plasma LA, fibrinogen, factor VIII (FVIII), and thrombosis incidence. A high frequency of LA and thrombosis were observed in both studies. In isolation LA, increased levels of FVIII and fibrinogen could not be considered good markers for the development of thrombosis.

Ischemic stroke subtypes and thrombophilia in young and elderly Brazilian stroke patients admitted to a rehabilitation hospital.

BACKGROUND AND PURPOSE: We sought to examine ischemic stroke subtypes and prevalence of thrombophilia in Brazilian stroke patients. METHOD: A total of 130 consecutive young and 200 elderly stroke patients were studied. RESULTS: Prevalence of thrombophilia was, respectively: protein S deficiency (11.5% versus 5.5%), protein C deficiency (0.76% versus 1%), resistance to activated protein C (2.3% versus 3.5%), mutation in V Leiden factor (1.5% versus 2%), antithrombin III deficiency (0% versus 0%), lupus anticoagulant (0% versus 0.5%), anticardiolipin antibodies (3% versus 10%; P=0.01), hyperhomocysteinemia (31.5% versus 53.5%; P=0.0001), mutation of the MTHFR gene in homocigosis (10% versus 5%), and heterocigosis (27.6% versus 41.9%; P=0.01). CONCLUSIONS: Prothrombotic conditions were more frequent in stroke of undetermined cause.

[Some considerations about the possible pathological mechanisms at work in antiphospholipid syndrome and stroke]. / Algunas consideraciones acerca de los posibles mecanismos patológicos en el síndrome antifosfolípidos e ictus.

INTRODUCTION AND DEVELOPMENT: Over the last two decades antiphospholipid syndrome (APS) has started to be recognized from the association of apparently anionic phospholipid-specific antibodies with thrombosis, thrombocytopenia and recurrent foetal losses. This syndrome affects patients with systemic lupus erythematosus and is considered to be an important cause of thromboembolic disease. Antiphospholipid antibodies are serum immunoglobulins that react with negatively charged phospholipids, albeit directly or by means of a cofactor, affect the coagulation system, and promote thrombosis. Recent research has been directed towards gaining an understanding of the mechanisms by which these antibodies are able to play a direct role in the pathophysiology of thrombosis, and the extent to which certain risk factors, such as smoking, high blood pressure, lipid disorders and so on, exert an influence over the expression of phospholipids in the cerebral endothelium. CONCLUSION: These antibodies have no single mechanism of action; different authors have described different pathological mechanisms, which help us to understand the heterogeneous clinical manifestations of APS.

[Antiphospholipid antibodies in patients with vestibular manifestations. A study of 16 cases]. / Anticuerpos antifosfolipídicos en pacientes con manifestaciones vestibulares. Un estudio de 16 casos.

INTRODUCTION: Antiphospholipid antibodies lupus anticoagulant (LA) and anticardiolipin antibodies (aCL) play a role in promoting arterial and venous thrombosis in several vascular territories. Acute vestibular syndromes are a common complaint in general and neurology practice. Approximately 9% of cases are due to central nervous system vestibular areas lesions, often associated with vascular disorders. OBJECTIVE: Define the potential relationship between these antibodies and central or peripheral vestibular failure. PATIENTS AND METHODS: We report the presence of antiphospholipid antibodies in 16 patients with central vestibular symptoms. All patients were seen in the Neuro otology and Vascular Neurology clinics at the Institute for Neurological Research in Buenos Aires. Magnetic resonance imaging (MRI) and ancillary neuro otologic tests were used to determine the etiology of vestibular manifestations. Determinations of LA and aCL were done using standard criteria. RESULTS: We evaluated 16 patients (13 women and 3 men), aged 44 4 years (21 65). Thirteen patients did not have stroke risk factors. MRI lesions were found in 11 subjects (1 cerebellar infarct, 3 pontine ischemic changes, and 9 white matter abnormalities). All patients had signs consistent with dysfunction of vestibulo cerebellar structures or the vestibular nuclei. All patients had positive LA and 4 of them had also elevated aCL. CONCLUSION: Our findings suggest a potential association between the presence of a prothrombotic state and central vestibular dysfunction of vascular etiology. To the best of our knowledge, this is the first report of such an association in the absence of clinically evident autoimmune disease.

Distribution of lupus anticoagulant and anticardiolipin antibody isotypes in a population with antiphospholipid syndrome.

OBJECTIVE: To analyze the distribution of lupus anticoagulant (LAC) and anticardiolipin antibody (aCL) isotypes in a population with antiphospholipid syndrome and to explore whether there is an association with the site of thrombotic episodes and the number of recurrent spontaneous abortions. METHODS: Ninety-two patients (73 female, 19 male) with positive LAC and/or aCL were included as 2 groups: (1) 20 patients with secondary antiphospholipid syndrome (APS) (16 had thrombotic episodes and 4 thrombocytopenia); (2) 72 patients with primary APS (31 presented thrombotic episodes and 41 had recurrent spontaneous abortion). RESULTS: In Group 1 seven of 20 (35%) patients with secondary APS had IgG aCL, 9 (45%) had both IgG/IgM aCL, and 2 (10%) had IgM aCL; the remaining patients had combinations of aCL isotypes. In Group 2 patients with primary APS, IgG aCL was positive in 41%, IgG/IgM mixture in 21%, and 15% of patients had combinations of the 3 isotypes. Sixteen of 20 (80%) patients with secondary disease and 37 of 72 (51%) with primary disease tested positive for LAC. CONCLUSION: The presence of one or any mixture of isotype of aCL with or without LAC is not associated with the site of thrombosis (venous or arterial). On the contrary, in the patients with primary APS, the presence of the 3 aCL isotypes plus LAC was associated with a higher number of recurrent spontaneous abortions compared to other possible combinations of aCL isotypes.