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Cause

Symptoms and Complications

Treatment

Lifestyle Changes

APS can occur in healthy individuals or people with an underlying autoimmune disorder likesystemic lupus erythematosus(SLE), also known as lupus.

An illustration with symptoms and complications of antiphospholipid syndrome

To be diagnosed, a person must have APSantibodies(immune system proteins) in addition to related symptoms like a history of blood clots and/or recurrentmiscarriages.

This article reviews what it means to have antiphospholipid syndrome, its symptoms and complications, and how it’s treated. Lifestyle habits to help prevent blood clots will also be discussed.

Antiphospholipid Syndrome: Why Does Clotting Happen?

Recurrent blood clots in arteries, veins, or small blood vessels are a cornerstone of antiphospholipid syndrome.

The antiphospholipid antibodies found in APS are:

The exact manner in which these antibodies lead to blood clot formation remains unknown. In fact, not everyone with these antibodies develops blood clots or has pregnancy complications.

Experts suspect a complex combination of genetic and environmental factors is involved. Specifically, genetically susceptible individuals with APS antibodies may develop blood clots when exposed to a trigger like trauma, surgery, or infection.Other factors, likevitamin D deficiency, could also play a role.

Secondary APS

APS is classified as either “primary” or “secondary.” Primary APS occurs independently, whereas secondary APS occurs with another autoimmune condition, usually lupus.

The link between APS and lupus is strong. Approximately 50% of people with APS eventually develop SLE.

While not a complete list, other autoimmune diseases associated with secondary APS include;

Blood Tests for Autoimmune Diseases

Symptoms and Complications of Antiphospholipid Syndrome

The two hallmark features of antiphospholipid syndrome are blood clots and pregnancy-related problems.

Blood Clots

In antiphospholipid syndrome, blood clots can form in any blood vessel, including thearteries(blood vessels that take oxygen-rich blood away from the heart) andveins(blood vessels that take oxygen-poor blood to the heart).

Blood clots usually only develop at one site, although they can continue to form if not treated. A rare exception is catastrophic APS, in which multiple blood clots form in a short time frame.

Types of blood clots seen in APS and their associated symptoms include:

Signs and Symptoms of a Blood Clot

Other health problems potentially seen in individuals with APS include:

Pregnancy-related complications may occur in antiphospholipid syndrome, including recurrent early miscarriage and fetal loss after 10 weeks gestation.

Late pregnancy complications like premature birth orfetal growth restrictionassociated with decreased blood flow to the fetus may also occur. The decreased blood flow is usually due to:

Is a Successful Pregnancy Possible With APS?Yes. Treatment of APS in pregnancy has improved outcomes to achieve successful live birth in more than 70% of pregnancies.

Is a Successful Pregnancy Possible With APS?

Yes. Treatment of APS in pregnancy has improved outcomes to achieve successful live birth in more than 70% of pregnancies.

Catastrophic Antiphospholipid Syndrome

Antiphospholipid syndrome affects around 1% to 5% of the population, and catastrophic APS—the most devastating form of the disease—affects less than 1% of those individuals.

In catastrophic APS, several blood clots develop in small, medium, and large blood vessels throughout the body quickly. Extensive and rapid blood-clotting can lead to the failure of organs, namely the lungs, kidneys, brain, skin, and heart.

It’s unclear exactly how catastrophic APS develops. Similar to typical APS, experts suspect to a trigger like an infection in genetically vulnerable individuals.

Survival With APSWhile catastrophic APS has amortality (death) rateof 50%,most people with APS live normal, healthy lives. In a European study that followed 1,000 people with APS, the survival probability (chance of living) at 10 years follow-up was nearly 91%.

Survival With APS

While catastrophic APS has amortality (death) rateof 50%,most people with APS live normal, healthy lives. In a European study that followed 1,000 people with APS, the survival probability (chance of living) at 10 years follow-up was nearly 91%.

Treatment to Manage Antiphospholipid Syndrome

A diagnosis of antiphospholipid syndrome requires the presence of symptoms consistent with APS (e.g., blood clot and/or pregnancy complication) and one or more persistently positive APS antibodies.“Persistently positive” means that at least one of the APS antibodies is present on a blood test taken at two separate times at least three months apart.

Once diagnosed with APS, anticoagulation is the mainstay of treatment. Also known asblood thinners, anticoagulants prevent existing blood clots from getting bigger and new blood clots from forming.

Anticoagulants used to treat blood clots in APS are:

In pregnancy, low-doseaspirinand/or LMWH may be used to prevent blood clots, miscarriage, or late pregnancy-related complications likepreeclampsiaandplacental insufficiency.

Warfarin is avoided in pregnancy when possible. It may be restarted soon after delivery and is generally considered safe to take while breastfeeding.

APS Treatment Is Not Always RecommendedIndividuals with antiphospholipid antibodies but no history of blood clots or pregnancy-related complications (if applicable) may not require any treatment.

Individuals with antiphospholipid antibodies but no history of blood clots or pregnancy-related complications (if applicable) may not require any treatment.

Lifestyle Changes With Antiphospholipid Syndrome

Various lifestyle practices can help reduce the risk of blood clot formation.

Such practices include:

Keep in mind too that if taking warfarin, you must undergo regularinternational normalized ratio (INR)blood tests.

Based on the INR level, your warfarin dose may be adjusted. An INR above the target range carries an increased risk of bleeding, and an INR below the target range carries an increased risk of clotting.

Taking Blood Thinners Before, During, and After Surgery

Also, it’s essential to maintain a stable intake ofvitamin Kwhen taking warfarin, as warfarin blocks a step in the blood-clotting process that depends on vitamin K. Consuming significantly lower or higher amounts of vitamin K can alter the INR, making you more prone to bleeding or clotting, respectively.

What Foods Are High in Vitamin K?Examples of foods high in vitamin K include kale, spinach, Brussels sprouts, collard greens, sushi, broccoli, and green tea.

What Foods Are High in Vitamin K?

Examples of foods high in vitamin K include kale, spinach, Brussels sprouts, collard greens, sushi, broccoli, and green tea.

Other medications, herbs, or dietary products like alcohol, cannabis,Ginkgo biloba,ginger, andSaint-John’s-wortcan also interfere with warfarin’s effect.

Speak with a healthcare provider before engaging in new dietary habits or taking a new prescription, recreational, or over-the-counter drug, vitamin, or supplement to avoid harmful interactions.

Summary

Antiphospholipid syndrome, or APS, is an autoimmune disease (when your immune system attacks its own tissue) associated with one of three APS antibodies, blood clots, and/or pregnancy-related complications, like recurrent miscarriages.

APS may occur on its own or with another autoimmune disease, namely lupus. While APS cannot be cured, it can be managed well in most cases with blood thinners, such as heparin, warfarin, or aspirin, depending on symptoms and the clinical scenario.

18 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Schreiber K, Sciascia S, de Groot PG, et al.Antiphospholipid syndrome.Nat Rev Dis Primers. 2018;4:17103. doi:10.1038/nrdp.2017.103Torres García J, Durán Agüero S.Fosfolípidos: propiedades y efectos sobre la salud [Phospholipids: properties and health effects].Nutr Hosp. 2014;31(1):76-83. doi:10.3305/nh.2015.31.1.7961Mezhov V, Segan JD, Tran H, Cicuttini FM.Antiphospholipid syndrome: a clinical review.Med J Aust. 2019;211(4):184-188. doi:10.5694/mja2.50262Lambroussis CG, Foster D, Sharma A.Antiphospholipid syndrome secondary to lupus anticoagulant: case report for clinical anticoagulation determination.Cureus. 2022;14(8):e27702. doi:10.7759/cureus.27702Shah R, Mohammed YN, Koehler TJ, et al.Antiphospholipid antibodies and vitamin D deficiency in COVID-19 infection with and without venous or arterial thrombosis: A pilot case-control study.PLoS One. 2022 Jul 14;17(7):e0269466. doi:10.1371/journal.pone.0269466D’Angelo C, Franch O, Fernández-Paredes L, et al.Antiphospholipid antibodies overlapping in isolated neurological syndrome and multiple sclerosis: neurobiological insights and diagnostic challenges.Front Cell Neurosci. 2019;13:107. doi:10.3389/fncel.2019.00107National Organization for Rare Disorders.Antiphospholipid syndrome.de Azevedo FVA, Maia DG, de Carvalho JF, Rodrigues CEM.Renal involvement in antiphospholipid syndrome.Rheumatol Int. 2018;38(10):1777-1789. doi:10.1007/s00296-018-4040-2Tomasello R, Giordano G, Romano F, et al.Immune thrombocytopenia in antiphospholipid syndrome: is it primary or secondary?Biomedicines. 2021;9(9):1170. doi:10.3390/biomedicines9091170Bernardoff I, Picq A, Loiseau P, et al.Antiphospholipid antibodies and the risk of autoimmune hemolytic anemia in patients with systemic lupus erythematosus: a systematic review and meta-analysis. Autoimmun Rev. 2022;21(1):102913. doi:10.1016/j.autrev.2021.102913Kolitz T, Shiber S, Sharabi I, Winder A, Zandman-Goddard G.Cardiac manifestations of antiphospholipid syndrome with focus on its primary form.Front Immunol. 2019;10:941. doi:10.3389/fimmu.2019.00941Ricarte IF, Dutra LA, Abrantes FF, et al.Neurologic manifestations of antiphospholipid syndrome.Lupus. 2018 Aug;27(9):1404-1414. doi:10.1177/0961203318776110Dupré A, Morel N, Yelnik C, et al.Cutaneous Involvement in Catastrophic Antiphospholipid Syndrome in a Multicenter Cohort of 65 Patients.JAMA Dermatol. 2023 Jan 1;159(1):62-67. doi: 10.1001/jamadermatol.2022.5221Petri M.Improvements in diagnosis and risk assessment of primary and secondary antiphospholipid syndrome. Hematology Am Soc Hematol Educ Program. 2019 Dec 6;2019(1):415-420. doi:10.1182/hematology.2019000046Cervera R, Serrano R, Pons-Estel GJ, et al.Morbidity and mortality in the antiphospholipid syndrome during a 10-year period: a multicentre prospective study of 1000 patients.Ann Rheum Dis. 2015;74(6):1011-1018. doi:10.1136/annrheumdis-2013-204838Tektonidou MG, Andreoli L, Limper M, Tincani A, Ward MM.Management of thrombotic and obstetric antiphospholipid syndrome: a systematic literature review informing the EULAR recommendations for the management of antiphospholipid syndrome in adults.RMD Open. 2019 Apr 28;5(1):e000924. doi:10.1136/rmdopen-2019-000924Lee EE, Jun JK, Lee EB.Management of women with antiphospholipid antibodies or antiphospholipid syndrome during pregnancy.J Korean Med Sci. 2021;36(4):e24. doi:10.3346/jkms.2021.36.e24Tan CSS, Lee SWH.Warfarin and food, herbal or dietary supplement interactions: a systematic review.Br J Clin Pharmacol. 2021;87(2):352-374. doi:10.1111/bcp.14404

18 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Schreiber K, Sciascia S, de Groot PG, et al.Antiphospholipid syndrome.Nat Rev Dis Primers. 2018;4:17103. doi:10.1038/nrdp.2017.103Torres García J, Durán Agüero S.Fosfolípidos: propiedades y efectos sobre la salud [Phospholipids: properties and health effects].Nutr Hosp. 2014;31(1):76-83. doi:10.3305/nh.2015.31.1.7961Mezhov V, Segan JD, Tran H, Cicuttini FM.Antiphospholipid syndrome: a clinical review.Med J Aust. 2019;211(4):184-188. doi:10.5694/mja2.50262Lambroussis CG, Foster D, Sharma A.Antiphospholipid syndrome secondary to lupus anticoagulant: case report for clinical anticoagulation determination.Cureus. 2022;14(8):e27702. doi:10.7759/cureus.27702Shah R, Mohammed YN, Koehler TJ, et al.Antiphospholipid antibodies and vitamin D deficiency in COVID-19 infection with and without venous or arterial thrombosis: A pilot case-control study.PLoS One. 2022 Jul 14;17(7):e0269466. doi:10.1371/journal.pone.0269466D’Angelo C, Franch O, Fernández-Paredes L, et al.Antiphospholipid antibodies overlapping in isolated neurological syndrome and multiple sclerosis: neurobiological insights and diagnostic challenges.Front Cell Neurosci. 2019;13:107. doi:10.3389/fncel.2019.00107National Organization for Rare Disorders.Antiphospholipid syndrome.de Azevedo FVA, Maia DG, de Carvalho JF, Rodrigues CEM.Renal involvement in antiphospholipid syndrome.Rheumatol Int. 2018;38(10):1777-1789. doi:10.1007/s00296-018-4040-2Tomasello R, Giordano G, Romano F, et al.Immune thrombocytopenia in antiphospholipid syndrome: is it primary or secondary?Biomedicines. 2021;9(9):1170. doi:10.3390/biomedicines9091170Bernardoff I, Picq A, Loiseau P, et al.Antiphospholipid antibodies and the risk of autoimmune hemolytic anemia in patients with systemic lupus erythematosus: a systematic review and meta-analysis. Autoimmun Rev. 2022;21(1):102913. doi:10.1016/j.autrev.2021.102913Kolitz T, Shiber S, Sharabi I, Winder A, Zandman-Goddard G.Cardiac manifestations of antiphospholipid syndrome with focus on its primary form.Front Immunol. 2019;10:941. doi:10.3389/fimmu.2019.00941Ricarte IF, Dutra LA, Abrantes FF, et al.Neurologic manifestations of antiphospholipid syndrome.Lupus. 2018 Aug;27(9):1404-1414. doi:10.1177/0961203318776110Dupré A, Morel N, Yelnik C, et al.Cutaneous Involvement in Catastrophic Antiphospholipid Syndrome in a Multicenter Cohort of 65 Patients.JAMA Dermatol. 2023 Jan 1;159(1):62-67. doi: 10.1001/jamadermatol.2022.5221Petri M.Improvements in diagnosis and risk assessment of primary and secondary antiphospholipid syndrome. Hematology Am Soc Hematol Educ Program. 2019 Dec 6;2019(1):415-420. doi:10.1182/hematology.2019000046Cervera R, Serrano R, Pons-Estel GJ, et al.Morbidity and mortality in the antiphospholipid syndrome during a 10-year period: a multicentre prospective study of 1000 patients.Ann Rheum Dis. 2015;74(6):1011-1018. doi:10.1136/annrheumdis-2013-204838Tektonidou MG, Andreoli L, Limper M, Tincani A, Ward MM.Management of thrombotic and obstetric antiphospholipid syndrome: a systematic literature review informing the EULAR recommendations for the management of antiphospholipid syndrome in adults.RMD Open. 2019 Apr 28;5(1):e000924. doi:10.1136/rmdopen-2019-000924Lee EE, Jun JK, Lee EB.Management of women with antiphospholipid antibodies or antiphospholipid syndrome during pregnancy.J Korean Med Sci. 2021;36(4):e24. doi:10.3346/jkms.2021.36.e24Tan CSS, Lee SWH.Warfarin and food, herbal or dietary supplement interactions: a systematic review.Br J Clin Pharmacol. 2021;87(2):352-374. doi:10.1111/bcp.14404

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Schreiber K, Sciascia S, de Groot PG, et al.Antiphospholipid syndrome.Nat Rev Dis Primers. 2018;4:17103. doi:10.1038/nrdp.2017.103Torres García J, Durán Agüero S.Fosfolípidos: propiedades y efectos sobre la salud [Phospholipids: properties and health effects].Nutr Hosp. 2014;31(1):76-83. doi:10.3305/nh.2015.31.1.7961Mezhov V, Segan JD, Tran H, Cicuttini FM.Antiphospholipid syndrome: a clinical review.Med J Aust. 2019;211(4):184-188. doi:10.5694/mja2.50262Lambroussis CG, Foster D, Sharma A.Antiphospholipid syndrome secondary to lupus anticoagulant: case report for clinical anticoagulation determination.Cureus. 2022;14(8):e27702. doi:10.7759/cureus.27702Shah R, Mohammed YN, Koehler TJ, et al.Antiphospholipid antibodies and vitamin D deficiency in COVID-19 infection with and without venous or arterial thrombosis: A pilot case-control study.PLoS One. 2022 Jul 14;17(7):e0269466. doi:10.1371/journal.pone.0269466D’Angelo C, Franch O, Fernández-Paredes L, et al.Antiphospholipid antibodies overlapping in isolated neurological syndrome and multiple sclerosis: neurobiological insights and diagnostic challenges.Front Cell Neurosci. 2019;13:107. doi:10.3389/fncel.2019.00107National Organization for Rare Disorders.Antiphospholipid syndrome.de Azevedo FVA, Maia DG, de Carvalho JF, Rodrigues CEM.Renal involvement in antiphospholipid syndrome.Rheumatol Int. 2018;38(10):1777-1789. doi:10.1007/s00296-018-4040-2Tomasello R, Giordano G, Romano F, et al.Immune thrombocytopenia in antiphospholipid syndrome: is it primary or secondary?Biomedicines. 2021;9(9):1170. doi:10.3390/biomedicines9091170Bernardoff I, Picq A, Loiseau P, et al.Antiphospholipid antibodies and the risk of autoimmune hemolytic anemia in patients with systemic lupus erythematosus: a systematic review and meta-analysis. Autoimmun Rev. 2022;21(1):102913. doi:10.1016/j.autrev.2021.102913Kolitz T, Shiber S, Sharabi I, Winder A, Zandman-Goddard G.Cardiac manifestations of antiphospholipid syndrome with focus on its primary form.Front Immunol. 2019;10:941. doi:10.3389/fimmu.2019.00941Ricarte IF, Dutra LA, Abrantes FF, et al.Neurologic manifestations of antiphospholipid syndrome.Lupus. 2018 Aug;27(9):1404-1414. doi:10.1177/0961203318776110Dupré A, Morel N, Yelnik C, et al.Cutaneous Involvement in Catastrophic Antiphospholipid Syndrome in a Multicenter Cohort of 65 Patients.JAMA Dermatol. 2023 Jan 1;159(1):62-67. doi: 10.1001/jamadermatol.2022.5221Petri M.Improvements in diagnosis and risk assessment of primary and secondary antiphospholipid syndrome. Hematology Am Soc Hematol Educ Program. 2019 Dec 6;2019(1):415-420. doi:10.1182/hematology.2019000046Cervera R, Serrano R, Pons-Estel GJ, et al.Morbidity and mortality in the antiphospholipid syndrome during a 10-year period: a multicentre prospective study of 1000 patients.Ann Rheum Dis. 2015;74(6):1011-1018. doi:10.1136/annrheumdis-2013-204838Tektonidou MG, Andreoli L, Limper M, Tincani A, Ward MM.Management of thrombotic and obstetric antiphospholipid syndrome: a systematic literature review informing the EULAR recommendations for the management of antiphospholipid syndrome in adults.RMD Open. 2019 Apr 28;5(1):e000924. doi:10.1136/rmdopen-2019-000924Lee EE, Jun JK, Lee EB.Management of women with antiphospholipid antibodies or antiphospholipid syndrome during pregnancy.J Korean Med Sci. 2021;36(4):e24. doi:10.3346/jkms.2021.36.e24Tan CSS, Lee SWH.Warfarin and food, herbal or dietary supplement interactions: a systematic review.Br J Clin Pharmacol. 2021;87(2):352-374. doi:10.1111/bcp.14404

Schreiber K, Sciascia S, de Groot PG, et al.Antiphospholipid syndrome.Nat Rev Dis Primers. 2018;4:17103. doi:10.1038/nrdp.2017.103

Torres García J, Durán Agüero S.Fosfolípidos: propiedades y efectos sobre la salud [Phospholipids: properties and health effects].Nutr Hosp. 2014;31(1):76-83. doi:10.3305/nh.2015.31.1.7961

Mezhov V, Segan JD, Tran H, Cicuttini FM.Antiphospholipid syndrome: a clinical review.Med J Aust. 2019;211(4):184-188. doi:10.5694/mja2.50262

Lambroussis CG, Foster D, Sharma A.Antiphospholipid syndrome secondary to lupus anticoagulant: case report for clinical anticoagulation determination.Cureus. 2022;14(8):e27702. doi:10.7759/cureus.27702

Shah R, Mohammed YN, Koehler TJ, et al.Antiphospholipid antibodies and vitamin D deficiency in COVID-19 infection with and without venous or arterial thrombosis: A pilot case-control study.PLoS One. 2022 Jul 14;17(7):e0269466. doi:10.1371/journal.pone.0269466

D’Angelo C, Franch O, Fernández-Paredes L, et al.Antiphospholipid antibodies overlapping in isolated neurological syndrome and multiple sclerosis: neurobiological insights and diagnostic challenges.Front Cell Neurosci. 2019;13:107. doi:10.3389/fncel.2019.00107

National Organization for Rare Disorders.Antiphospholipid syndrome.

de Azevedo FVA, Maia DG, de Carvalho JF, Rodrigues CEM.Renal involvement in antiphospholipid syndrome.Rheumatol Int. 2018;38(10):1777-1789. doi:10.1007/s00296-018-4040-2

Tomasello R, Giordano G, Romano F, et al.Immune thrombocytopenia in antiphospholipid syndrome: is it primary or secondary?Biomedicines. 2021;9(9):1170. doi:10.3390/biomedicines9091170

Bernardoff I, Picq A, Loiseau P, et al.Antiphospholipid antibodies and the risk of autoimmune hemolytic anemia in patients with systemic lupus erythematosus: a systematic review and meta-analysis. Autoimmun Rev. 2022;21(1):102913. doi:10.1016/j.autrev.2021.102913

Kolitz T, Shiber S, Sharabi I, Winder A, Zandman-Goddard G.Cardiac manifestations of antiphospholipid syndrome with focus on its primary form.Front Immunol. 2019;10:941. doi:10.3389/fimmu.2019.00941

Ricarte IF, Dutra LA, Abrantes FF, et al.Neurologic manifestations of antiphospholipid syndrome.Lupus. 2018 Aug;27(9):1404-1414. doi:10.1177/0961203318776110

Dupré A, Morel N, Yelnik C, et al.Cutaneous Involvement in Catastrophic Antiphospholipid Syndrome in a Multicenter Cohort of 65 Patients.JAMA Dermatol. 2023 Jan 1;159(1):62-67. doi: 10.1001/jamadermatol.2022.5221

Petri M.Improvements in diagnosis and risk assessment of primary and secondary antiphospholipid syndrome. Hematology Am Soc Hematol Educ Program. 2019 Dec 6;2019(1):415-420. doi:10.1182/hematology.2019000046

Cervera R, Serrano R, Pons-Estel GJ, et al.Morbidity and mortality in the antiphospholipid syndrome during a 10-year period: a multicentre prospective study of 1000 patients.Ann Rheum Dis. 2015;74(6):1011-1018. doi:10.1136/annrheumdis-2013-204838

Tektonidou MG, Andreoli L, Limper M, Tincani A, Ward MM.Management of thrombotic and obstetric antiphospholipid syndrome: a systematic literature review informing the EULAR recommendations for the management of antiphospholipid syndrome in adults.RMD Open. 2019 Apr 28;5(1):e000924. doi:10.1136/rmdopen-2019-000924

Lee EE, Jun JK, Lee EB.Management of women with antiphospholipid antibodies or antiphospholipid syndrome during pregnancy.J Korean Med Sci. 2021;36(4):e24. doi:10.3346/jkms.2021.36.e24

Tan CSS, Lee SWH.Warfarin and food, herbal or dietary supplement interactions: a systematic review.Br J Clin Pharmacol. 2021;87(2):352-374. doi:10.1111/bcp.14404

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