From Diagnosis to Treatment: Exploring Vascular Thrombosis in Antiphospholipid Syndrome Through a Case Report and Literature Review

Abstract

Background: Antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by recurrent arterial or venous thrombosis and pregnancy morbidity in the presence of antiphospholipid antibodies (aPLs). Maintaining therapeutic anticoagulation is critical to prevent recurrent thrombotic events, particularly in high-risk individuals.

Case Presentation: We present a 33-year-old male with primary APS, a history of recurrent thrombotic events, and poor compliance with anticoagulation therapy, who presented with sudden-onset chest pain and dyspnea. Imaging confirmed pulmonary embolism (PE) with a solitary pulmonary nodule and ground-glass opacities. Echocardiography revealed moderate right ventricular dilatation, a small pericardial effusion, and an inferior vena cava fibrin clot. Laboratory findings confirmed primary APS with positive lupus anticoagulant and elevated beta-2 glycoprotein IgG. The patient was treated with low molecular weight heparin bridged to warfarin, achieving therapeutic INR, and discharged on lifelong anticoagulation.

Discussion: This case underscores the high risk of recurrent thrombosis in APS patients who discontinue anticoagulation therapy. It highlights the importance of a multidisciplinary approach to management, patient education, and adherence to therapeutic anticoagulation. Current management strategies, challenges in risk stratification, and emerging therapies are discussed, emphasizing the potential for rapid recurrence upon treatment discontinuation.

Conclusion: Lifelong anticoagulation remains the cornerstone of APS management to prevent recurrent thrombotic events. Close monitoring, patient education, and a multidisciplinary approach are essential to optimize outcomes and prevent complications in APS patients.