To our knowledge there is limited literature on the progression of white matter lesions (WMLs) in Antiphospholipid syndrome (APS) when anticoagulation is commenced. Thus, it is our aim to conduct a retrospective observational study to determine ifthere is any change in the burden of WMLs in patients with APS who areon anticoagulation for a previous thrombotic event. We also reviewed studies for any additional complications of anticoagulation e.g. cerebral haemorrhage.

Vascular thrombosis is one of the established criteria for the diagnosis of APSwith the cerebral circulation being the second most common site after the deep leg veins(1). As well as having an increased risk of cerebral thrombosis, patients with APS also have a greater burden of WMLs than age-matched controls (2). The exact pathophysiology remains uncertain and is hypothesised to involve endothelial, autoantibody and complement activation (4). The mainstay of treatment for APS is antiplatelet and/or anticoagulation therapy. Complications of anticogulation or disease progression e.g....

Procedure details: A retrospective study of available Magnetic Resonance Imaging (MRI) brain studies for a cohort of patients with APS established on anticoagulation over a maximum period of 9 years was conducted. The number of MRIs for individual patients varied and in the vast majority were symptomatically indicated e.g. headache. The cases were reviewed by two reporting Radiology Specialty Registrars (StRs) at Guy’s and St Thomas’ Hospital, London. If there was a discordance in findings the study was arbitrated by a Consultant Neuroradiologist. The burden...

Our retrospective observational study found that few cases demonstrated WML progression. However 12% developed an acute infarct and 4% acute haemorrhage; an important clinical consideration for patients that are aggressively anticoagulated with neurological APS. Further evaluation into WML progression in those not commenced on anticoagulation is required to examine the effect of anticoagulation.

1) Miyakis S, Lockshin MD, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS).J Thromb Haemost.2006;4(2):295–306. 2) Cervera R, Piette JC, Font J, et al. Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1000 patients. Arthritis Rheum.2002;46(4):1019–1027. 3) Fazekas F, Chawluk JB, Alavi A et-al. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal ageing. AJR Am J Roentgenol. 1987;149(2): 351-6. 4) Arachchillage, D. R.J. and...