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Antiphospholipid Syndrome — EECC MCQ

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ModerateGeneral CardiologyAntiphospholipid SyndromeEECC

A 55-year-old woman with recurrent unprovoked DVTs and bilateral adrenal haemorrhage has a positive lupus anticoagulant and persistent high-titre anticardiolipin antibodies on two occasions 12 weeks apart. She now develops Libman-Sacks endocarditis with mild MR. What underlying condition unifies these findings?

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Correct answer: C — Antiphospholipid syndrome (APS) — characterised by arterial/venous thrombosis, pregnancy morbidity, and persistent antiphospholipid antibodies; cardiac manifestations include Libman-Sacks endocarditis and valve thickening

Antiphospholipid syndrome (APS) is defined by clinical events (vascular thrombosis and/or pregnancy morbidity) combined with persistent antiphospholipid antibodies (lupus anticoagulant, anticardiolipin, anti-beta-2 glycoprotein I antibodies on two occasions ≥12 weeks apart). Cardiac manifestations include: (1) Libman-Sacks endocarditis (sterile valve vegetations, particularly mitral and aortic); (2) valve thickening and regurgitation; (3) intracardiac thrombus; (4) accelerated atherosclerosis; (5) myocardial microthrombi. APS may be primary or secondary to SLE. Treatment requires lifelong anticoagulation with warfarin (DOACs are NOT recommended in APS based on the TRAPS trial showing increased thrombotic events with rivaroxaban). Target INR is 2.0-3.0 for venous thrombosis, ≥3.0 for arterial events.

Reference: ESC/EULAR APS Guidelines; TRAPS Trial