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Stroke and the antiphospholipid syndrome: consensus meeting Taormina 2002

Department of Medicine, Division of Neurology, University of Texas Health Science Center - San Antonio, Texas, USA, brey{at}uthscsa.edu

J Chapman

Department of Neurology, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel

S R Levine

Stroke Program, Department of Neurology, The Mount Sinai School of Medicine, New York, USA

G Ruiz-Irastorza

Service of Internal Medicine, Hospital de Cruces, Department of Medicine, University of the Basque Country, 48903-Bizkaia, Spain

R HWM Derksen

Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht, The Netherlands

M Khamashta

Lupus Unit, The Rayne Institute, St Thomas’ Hospital, London, UK

Y Shoenfeld

Department of Medicine B and Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University, Israel

Ischaemic stroke is the only neurological manifestation accepted as a clinical diagnostic criterion for the antiphospholipidsyndrome (APS). This association is reasonably well established in patients first diagnosed with APS but is less clear in randomly selected stroke patients who test positive on one occasion for antiphospholipid antibodies and who have no other evidence of systemic autoimmune disease. We propose a grading system that posits stroke to be definitely, likely or possibly associated with antiphospholipid antibodies (aPL). Further, there are limited prospective data to determine appropriatetreatment. There is controversy as to whether the presence of aPL even increases risk of a recurrent stroke or other thromboembolic event, although data point to persistent medium-high titre aCL and/or LA as risk factors for recurrence. In the absence of data to guide clinicians on the best treatment, we cannot make strong recommendations as to optimal therapy, nor can we propose clear consensus treatment guidelines.

Key Words: anticoagulanttherapy • antiphospholipidantibodies • antiphospholipidsyndrome • cerebrovascular disorders • lupus anticoagulant • stroke

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