This is a disease that very rarely occurs in a population. 9% of women with fetal loss syndrome, 10% of patients with deep venous thrombosis, 14% of patients with cerebrovascular accidents are thought to develop these life-threatening conditions exactly because of APS. I.e. the frequency in the general population is many times lower. The obsession of the Russian medical science with this grave condition is absolutely incomprehensible and unaccountable. Aside from that, it is also dangerous…
So in what cases can a doctor make such a diagnosis?
In 2006, STRINGENT criteria (Sydney criteria) were devised giving or denying a doctor the right to label a patient with this diagnosis.
Let us take a look on those:
1. Clinical criteria are what you have in your medical history:
- Vascular thrombosis in an organ or tissue without inflammation (i.e. superficial phlebitis and varicose veins do not count).
- Pregnancy pathology (one or more unaccountable pregnancy terminations after 10 weeks of gestation, or one or more deliveries before 34 weeks with grave gestosis, or three or more unaccountable pregnancy terminations before 10 weeks).
I.e. if you did not have thrombotic episodes or pregnancies before you should not focus on APS
2. Laboratory criteria:
- High-titer anticardiolipin ABs (>40 u/ml) detected twice by immune-ferment analysis.
- High-titer B2-glycoprotein ABs (>40 u/ml) detected twice by immune-ferment analysis.
- Lupus anticoagulant – dRVVT test (Dilute Russell's viper venom test), APTT.
APS CAN BE DIAGNOSED ONLY WHEN THERE IS A COMBINATION OF AT LEAST ONE CLINICAL AND ONE LABAROTORY CRITERION.
Patients with a VALID APS diagnosis are to undergo therapy with LMWH and low doses of Aspirin during pregnancy. Nothing else can be of use here: neither glucocorticoids nor immunoglobulins nor plasmapheresis. One should also remember at all times that even if the hemostatic system is compensated, pregnancy in this group of patients remains of high risk until the very delivery!
In case there have been no thromboses in medical history, the "preparation" for pregnancy via months of therapy with LMWH, Aspirin, Vessel Due and hirudotherpy is not due. The world knows nothing of this APS therapeutic method. And there is certainly no such diagnosis as "the carriage of antiphospholipid AB" or "Tentative APS" when "some other" titers of other clinically irrelevant AB are detected. IVF failures are also no reason to start looking for signs of antiphospholipid syndrome.