Primary Antiphospholipid Syndrome: Indications for Long-Term Anticoagulation

Primary antiphospholipid syndrome, defined as the presence of antiphospholipid antibodies with recurrent thrombosis in patients who have no clinical or serologic features of systemic lupus erythematosus, is now a medically recognizable and treatable disorder. 1 The syndrome is associ-ated with a high incidence of recurrent arterial and venous occlusions, with cerebrovascular thrombi occurring second in frequency only to deep vein thrombi.2 Current recommendations are to screen for antiphospholipid antibodies in all patients younger than 45 years (even those with risk factors for thromboses) who have had a thrombotic event, as well as in patients who have clinical features of systemic lupus erythematosus or who have had more than two miscarriages.3 The case presented here illustrates the challenge and importance of recognizing primary antiphos-pholipid syndrome in a family practice. Case Report The patient was a 37-year-old, obese woman who had non-insulin-dependent diabetes mellitus and hypertension and who smoked marijuana and to-bacco (one pack per day for 4 years). She devel-oped sudden left arm pain and neck numbness the day of admission. Several months earlier she had an episode of word-finding difficulty lasting less than 24 hours; her speech was normal on examination several days later. At that time a non enhanced computed axial tomography (CI) scan of her head showed a small, low-density region in the left frontal white matter that was nonspecific and less conspicuous on magnetic resonance imaging a few days later. One month later a repeat CT scan with contrast medium showed that the lesion had resolved. She had mild dyspepsia; otherwise, her medica