Antiphospholipid Antibodies and Subsequent Thrombo-occlusive Events in Patients With Ischemic Stroke

KNOWLEDGE OF WELL-ESTABlished risk factors for recurrent stroke only partially predicts the occurrence of new events, which has led to a search for new risk factors. Several potential hematologic markers of hypercoagulability, including antiphospholipid antibodies (aPL) have been associated with vascular thrombo-occlusive events in most, but not all case-control studies. In prospective studies, aPL positivity has been associated with initial thrombotic events including stroke, ,13 although not consistently. The role of aPL in predicting recurrent ischemic events, particularly recurrent ischemic stroke, is controversial. Antiphospholipid antibodies, both anticardiolipin antibodies (aCL) and lupus anticoagulant antibodies (LA), have been linked to an immune-mediated coagulopathy and left-sided cardiac valvular lesions. In the absence of prospective, controlled clinical trial data, recommendations have been put forth for the use of long-term, highintensity anticoagulation in the management of symptomatic patients testing positive for aPL. Because all prior studies investigating the role of aPL and recurrent events have been compromised by small sample sizes, lack of blinded or standardized therapy, and lack of adjudicated end points, we *Authors: The APASS Writing Committee. The Members of the APASS Writing Committee and Study Investigators are listed at the end of this article. Corresponding Author and Reprints: Steven R. Levine, MD, Stroke Program, Box 1137, Department of Neurology, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029-6574 (e-mail: [email protected]). Context The presence of antiphospholipid antibodies (aPL) has been associated with vascular occlusive events. However, the role of aPL in predicting ischemic events, particularly recurrent ischemic stroke, is controversial.