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Published in: Current Neurology and Neuroscience Reports 8/2021

01-08-2021 | Multiple Sclerosis | Neurology of Systemic Diseases (J. Biller, Section Editor)

Neurologic Manifestations of the Antiphospholipid Syndrome — an Update

Authors: Miguel Leal Rato, Matilde Bandeira, Vasco C. Romão, Diana Aguiar de Sousa

Published in: Current Neurology and Neuroscience Reports | Issue 8/2021

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Abstract

Purpose of Review

In recent years, the spectrum of neurological manifestations of antiphospholipid syndrome (APS) has been growing. We provide a critical review of the literature with special emphasis on presentation, proposed mechanisms of disease, and treatment of neurological involvement in APS.

Recent Findings

Although stroke is the most common cause of neurological manifestations in patients with APS, other neurological disorders have been increasingly associated with the disease, including cognitive dysfunction, headache, and epilepsy. Direct oral anticoagulants have failed to show non-inferiority compared to vitamin K antagonists for the prevention of major thrombotic events. Antiphospholipid antibodies are often found in patients with acute COVID-19 but clear evidence supporting an association between these antibodies and the risk of thrombotic events, including stroke and cerebral venous thrombosis, is still lacking.

Summary

APS patients may present with several distinct neurological manifestations. New criteria will facilitate the classification of patients presenting with increasingly recognized non-criteria neurological manifestations.
Literature
11.
go back to reference Gharavi AE, Sammaritano LR, Wen J, Miyawaki N, Morse JH, Zarrabi MH, et al. Characteristics of human immunodeficiency virus and chlorpromazine induced antiphospholipid antibodies: effect of beta 2 glycoprotein I on binding to phospholipid. J Rheumatol. 1994;21(1):94–9.PubMed Gharavi AE, Sammaritano LR, Wen J, Miyawaki N, Morse JH, Zarrabi MH, et al. Characteristics of human immunodeficiency virus and chlorpromazine induced antiphospholipid antibodies: effect of beta 2 glycoprotein I on binding to phospholipid. J Rheumatol. 1994;21(1):94–9.PubMed
16.
go back to reference Barbhaiya M, Zuily S, Ahmadzadeh Y, et al. Development of new international antiphospholipid syndrome classification criteria phase I/II report: generation and reduction of candidate criteria.; 2020. doi:10.1002/acr.24520 Barbhaiya M, Zuily S, Ahmadzadeh Y, et al. Development of new international antiphospholipid syndrome classification criteria phase I/II report: generation and reduction of candidate criteria.; 2020. doi:10.1002/acr.24520
18.
go back to reference Shi H, Zheng H, Yin Y-F, Hu QY, Teng JL, Sun Y, et al. Antiphosphatidylserine/prothrombin antibodies (aPS/PT) as potential diagnostic markers and risk predictors of venous thrombosis and obstetric complications in antiphospholipid syndrome. Clin Chem Lab Med. 2018;56(4):614–24. https://doi.org/10.1515/cclm-2017-0502.CrossRefPubMed Shi H, Zheng H, Yin Y-F, Hu QY, Teng JL, Sun Y, et al. Antiphosphatidylserine/prothrombin antibodies (aPS/PT) as potential diagnostic markers and risk predictors of venous thrombosis and obstetric complications in antiphospholipid syndrome. Clin Chem Lab Med. 2018;56(4):614–24. https://​doi.​org/​10.​1515/​cclm-2017-0502.CrossRefPubMed
21.
go back to reference •• Volkov I, Seguro L, Leon EP, et al. Profiles of criteria and non-criteria anti-phospholipid autoantibodies are associated with clinical phenotypes of the antiphospholipid syndrome. Auto- Immun highlights. 2020;11(1):8. https://doi.org/10.1186/s13317-020-00131-3Recent study mainly on non-criteria aPLs. First study to correlate CNS manifestations to a specific aPL profile, with simultaneous positivity for IgG antibodies against prothrombin, phosphatidylglycerol, phosphatidylinositol, and annexin-5.CrossRefPubMedPubMedCentral •• Volkov I, Seguro L, Leon EP, et al. Profiles of criteria and non-criteria anti-phospholipid autoantibodies are associated with clinical phenotypes of the antiphospholipid syndrome. Auto- Immun highlights. 2020;11(1):8. https://​doi.​org/​10.​1186/​s13317-020-00131-3Recent study mainly on non-criteria aPLs. First study to correlate CNS manifestations to a specific aPL profile, with simultaneous positivity for IgG antibodies against prothrombin, phosphatidylglycerol, phosphatidylinositol, and annexin-5.CrossRefPubMedPubMedCentral
22.
go back to reference Zhang S, Wu Z, Li J, Li P, Chen S, Wen X, et al. Clinical performance of antibodies to prothrombin and thrombin in Chinese patients with antiphospholipid syndrome: potential interest in discriminating patients with thrombotic events and non-thrombotic events. Rheumatol Int. 2017;37(4):579–84. https://doi.org/10.1007/s00296-016-3594-0.CrossRefPubMed Zhang S, Wu Z, Li J, Li P, Chen S, Wen X, et al. Clinical performance of antibodies to prothrombin and thrombin in Chinese patients with antiphospholipid syndrome: potential interest in discriminating patients with thrombotic events and non-thrombotic events. Rheumatol Int. 2017;37(4):579–84. https://​doi.​org/​10.​1007/​s00296-016-3594-0.CrossRefPubMed
33.
go back to reference Nakamura H, Oku K, Amengual O, Ohmura K, Fujieda Y, Kato M, et al. First-line, non-criterial antiphospholipid antibody testing for the diagnosis of antiphospholipid syndrome in clinical practice: a combination of anti-β(2) -glycoprotein I domain I and anti-phosphatidylserine/prothrombin complex antibodies tests. Arthritis Care Res. 2018;70(4):627–34. https://doi.org/10.1002/acr.23310.CrossRef Nakamura H, Oku K, Amengual O, Ohmura K, Fujieda Y, Kato M, et al. First-line, non-criterial antiphospholipid antibody testing for the diagnosis of antiphospholipid syndrome in clinical practice: a combination of anti-β(2) -glycoprotein I domain I and anti-phosphatidylserine/prothrombin complex antibodies tests. Arthritis Care Res. 2018;70(4):627–34. https://​doi.​org/​10.​1002/​acr.​23310.CrossRef
35.
go back to reference Núñez-Álvarez CA, Hernández-Molina G, Bermúdez-Bermejo P, Zamora-Legoff V, Hernández-Ramírez DF, Olivares-Martínez E, et al. Prevalence and associations of anti-phosphatidylserine/prothrombin antibodies with clinical phenotypes in patients with primary antiphospholipid syndrome: aPS/PT antibodies in primary antiphospholipid syndrome. Thromb Res. 2019;174:141–7. https://doi.org/10.1016/j.thromres.2018.12.023.CrossRefPubMed Núñez-Álvarez CA, Hernández-Molina G, Bermúdez-Bermejo P, Zamora-Legoff V, Hernández-Ramírez DF, Olivares-Martínez E, et al. Prevalence and associations of anti-phosphatidylserine/prothrombin antibodies with clinical phenotypes in patients with primary antiphospholipid syndrome: aPS/PT antibodies in primary antiphospholipid syndrome. Thromb Res. 2019;174:141–7. https://​doi.​org/​10.​1016/​j.​thromres.​2018.​12.​023.CrossRefPubMed
38.
go back to reference • Cervera R, Boffa MC, Khamashta MA, Hughes GRV. The Euro-Phospholipid project: epidemiology of the antiphospholipid syndrome in Europe. Lupus. 2009;18(10):889–93. https://doi.org/10.1177/0961203309106832The Euro-Phospholipid cohort includes 1000 primary and secondary APS patients and detailed prevalence of different clinical manifestations, including neurological and other non-criteria manifestations.CrossRefPubMed • Cervera R, Boffa MC, Khamashta MA, Hughes GRV. The Euro-Phospholipid project: epidemiology of the antiphospholipid syndrome in Europe. Lupus. 2009;18(10):889–93. https://​doi.​org/​10.​1177/​0961203309106832​The Euro-Phospholipid cohort includes 1000 primary and secondary APS patients and detailed prevalence of different clinical manifestations, including neurological and other non-criteria manifestations.CrossRefPubMed
41.
go back to reference Erkan D, Barbhaiya M, George D, Sammaritano L, Lockshin M. Moderate versus high-titer persistently anticardiolipin antibody positive patients: are they clinically different and does high-titer anti-beta 2-glycoprotein-I antibody positivity offer additional predictive information? Lupus. 2010;19(5):613–9. https://doi.org/10.1177/0961203309355300.CrossRefPubMed Erkan D, Barbhaiya M, George D, Sammaritano L, Lockshin M. Moderate versus high-titer persistently anticardiolipin antibody positive patients: are they clinically different and does high-titer anti-beta 2-glycoprotein-I antibody positivity offer additional predictive information? Lupus. 2010;19(5):613–9. https://​doi.​org/​10.​1177/​0961203309355300​.CrossRefPubMed
43.
go back to reference Andreoli L, Chighizola CB, Banzato A, Pons-Estel GJ, De Jesus GR, Erkan D. Estimated frequency of antiphospholipid antibodies in patients with pregnancy morbidity, stroke, myocardial infarction, and deep vein thrombosis: a critical review of the literature. Arthritis Care Res. 2013;65(11):1869–73. https://doi.org/10.1002/acr.22066.CrossRef Andreoli L, Chighizola CB, Banzato A, Pons-Estel GJ, De Jesus GR, Erkan D. Estimated frequency of antiphospholipid antibodies in patients with pregnancy morbidity, stroke, myocardial infarction, and deep vein thrombosis: a critical review of the literature. Arthritis Care Res. 2013;65(11):1869–73. https://​doi.​org/​10.​1002/​acr.​22066.CrossRef
49.
go back to reference Roldan JF, Brey RL. Neurologic Manifestations of the antiphospholipid syndrome. Curr Rheumatol Rep. 2007;9:109–15.CrossRef Roldan JF, Brey RL. Neurologic Manifestations of the antiphospholipid syndrome. Curr Rheumatol Rep. 2007;9:109–15.CrossRef
51.
go back to reference Provenzale JM, Barboriak DP, Allen NB, Ortel TL. Antiphospholipid antibodies: findings at arteriography. Am J Neuroradiol. 1998;19(4):611–6.PubMed Provenzale JM, Barboriak DP, Allen NB, Ortel TL. Antiphospholipid antibodies: findings at arteriography. Am J Neuroradiol. 1998;19(4):611–6.PubMed
57.
go back to reference Provenzale JM, Barboriak DP, Alen NB, Ortel TL. Patients with antiphospholipid antibodies: CT and MR findings of the brain. AJR. 1996;167:1573–8.CrossRef Provenzale JM, Barboriak DP, Alen NB, Ortel TL. Patients with antiphospholipid antibodies: CT and MR findings of the brain. AJR. 1996;167:1573–8.CrossRef
62.
64.
go back to reference Francès C, Papo T, Wechsler B, Laporte J-L, Biousse V, Piette J-C. Sneddon syndrome with or without antiphospholipid antibodies: a comparative study in 46 patients. Medicine (Baltimore). 1999;78(4):209–19.CrossRef Francès C, Papo T, Wechsler B, Laporte J-L, Biousse V, Piette J-C. Sneddon syndrome with or without antiphospholipid antibodies: a comparative study in 46 patients. Medicine (Baltimore). 1999;78(4):209–19.CrossRef
69.
go back to reference Shoenfeld Y, Lev S, Blatt I, Blank M, Font J, von Landenberg P, et al. Features associated with epilepsy in the antiphospholipid syndrome. J Rheumatol. 2004;31(7):1344–8.PubMed Shoenfeld Y, Lev S, Blatt I, Blank M, Font J, von Landenberg P, et al. Features associated with epilepsy in the antiphospholipid syndrome. J Rheumatol. 2004;31(7):1344–8.PubMed
76.
go back to reference Erkan D, Barbhaiya M, George D, Sammaritano L, Lockshin M. Moderate versus high-titer persistently anticardiolipin antibody positive patients: are they clinically different and does high-titer anti- β2-glycoprotein-I antibody positivity offer additional predictive information? Lupus. 2010;19(5):613–9. https://doi.org/10.1177/0961203309355300.CrossRefPubMed Erkan D, Barbhaiya M, George D, Sammaritano L, Lockshin M. Moderate versus high-titer persistently anticardiolipin antibody positive patients: are they clinically different and does high-titer anti- β2-glycoprotein-I antibody positivity offer additional predictive information? Lupus. 2010;19(5):613–9. https://​doi.​org/​10.​1177/​0961203309355300​.CrossRefPubMed
91.
go back to reference • Cavestro C, Degan D, Micca G, et al. Thrombophilic alterations, migraine, and vascular disease: results from a case-control study. Neurol Sci. 2021. https://doi.org/10.1007/s10072-020-05006-zA recent case-control study on the association between migraine, thrombophilic conditions, and vascular events. • Cavestro C, Degan D, Micca G, et al. Thrombophilic alterations, migraine, and vascular disease: results from a case-control study. Neurol Sci. 2021. https://​doi.​org/​10.​1007/​s10072-020-05006-zA recent case-control study on the association between migraine, thrombophilic conditions, and vascular events.
93.
go back to reference • Schofield JR, Hughes HN, Birlea M, Hassell KL. A trial of antithrombotic therapy in patients with refractory migraine and antiphospholipid antibodies: a retrospective study of 75 patients. Lupus. 2021. https://doi.org/10.1177/0961203320983913A retrospective study of 75 patients with refractory migraine and aPL who were given a 2–4-week trial of antiplatelets or anticoagulation showed a high rate of symptomatic response to antithrombotic therapy and a low bleeding risk on long-term follow-up. • Schofield JR, Hughes HN, Birlea M, Hassell KL. A trial of antithrombotic therapy in patients with refractory migraine and antiphospholipid antibodies: a retrospective study of 75 patients. Lupus. 2021. https://​doi.​org/​10.​1177/​0961203320983913​A retrospective study of 75 patients with refractory migraine and aPL who were given a 2–4-week trial of antiplatelets or anticoagulation showed a high rate of symptomatic response to antithrombotic therapy and a low bleeding risk on long-term follow-up.
94.
go back to reference •• 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. https://doi.org/10.3389/fncel.2019.00107An insightfully written review on the pathophysiological mechanisms of neuroimmune disorders associated with APS, with a particular focus on multiple sclerosis. •• 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. https://​doi.​org/​10.​3389/​fncel.​2019.​00107An insightfully written review on the pathophysiological mechanisms of neuroimmune disorders associated with APS, with a particular focus on multiple sclerosis.
96.
go back to reference Cuadrado MJ, Khamashta MA, Ballesteros A, Godfrey T, Simon MJ, Hughes G. Can Neurologic manifestations of Hughes (antiphospholipid) syndrome be distinguished from multiple sclerosis. Medicine (Baltimore). 2000;79:57–68.CrossRef Cuadrado MJ, Khamashta MA, Ballesteros A, Godfrey T, Simon MJ, Hughes G. Can Neurologic manifestations of Hughes (antiphospholipid) syndrome be distinguished from multiple sclerosis. Medicine (Baltimore). 2000;79:57–68.CrossRef
102.
go back to reference Collard RC, Koehler RP, Mattson DH. Frequency and significance of antinuclear antibodies in multiple sclerosis.; 1997. Collard RC, Koehler RP, Mattson DH. Frequency and significance of antinuclear antibodies in multiple sclerosis.; 1997.
106.
go back to reference Rovaris M, Viti B, Ciboddo G, Gerevini S, Capra R, Iannucci G, et al. Brain involvement in systemic immune mediated diseases: magnetic resonance and magnetisation transfer imaging study. J Neurol Neurosurg Psychiatry. 2000;68:170–7.CrossRef Rovaris M, Viti B, Ciboddo G, Gerevini S, Capra R, Iannucci G, et al. Brain involvement in systemic immune mediated diseases: magnetic resonance and magnetisation transfer imaging study. J Neurol Neurosurg Psychiatry. 2000;68:170–7.CrossRef
108.
go back to reference Sastre-Garriga J, Reverter J c, Font J, Tintoré M, Espinosa G, Montalban X. Anticardiolipin antibodies are not a useful screening tool in a nonselected large group of patients with multiple sclerosis. Ann Neurol. 2001;49:408–11.CrossRef Sastre-Garriga J, Reverter J c, Font J, Tintoré M, Espinosa G, Montalban X. Anticardiolipin antibodies are not a useful screening tool in a nonselected large group of patients with multiple sclerosis. Ann Neurol. 2001;49:408–11.CrossRef
111.
go back to reference Wingerchuk DM, Banwell B, Bennett JL, Cabre P, Carroll W, Chitnis T, et al. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology. 2015;85(2):177–89.CrossRef Wingerchuk DM, Banwell B, Bennett JL, Cabre P, Carroll W, Chitnis T, et al. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology. 2015;85(2):177–89.CrossRef
118.
go back to reference Sherer Y, Hassin S, Shoenfeld Y, et al. Transverse myelitis in patients with antiphospholipid antibodies-the importance of early diagnosis and treatment. Sherer Y, Hassin S, Shoenfeld Y, et al. Transverse myelitis in patients with antiphospholipid antibodies-the importance of early diagnosis and treatment.
121.
go back to reference Cervera R, Asherson RA, Font J, Tikly M, Pallarés L, Chamorro A, et al. Chorea in the antiphospholipid syndrome: clinical, radiologic, and immunologic characteristics of 50 patients from our clinics and the recent literature. Med. 1997;76(3):203–12.CrossRef Cervera R, Asherson RA, Font J, Tikly M, Pallarés L, Chamorro A, et al. Chorea in the antiphospholipid syndrome: clinical, radiologic, and immunologic characteristics of 50 patients from our clinics and the recent literature. Med. 1997;76(3):203–12.CrossRef
128.
go back to reference Jeruc J. Multiple mononeuropathy due to vasculitis associated with anticardiolipin antibodies: a case report. Vol 44.; 2006. Jeruc J. Multiple mononeuropathy due to vasculitis associated with anticardiolipin antibodies: a case report. Vol 44.; 2006.
130.
go back to reference Gilburd B, Stein M, Tomer Y, Tanne D, Abramski O, Chapman Y, et al. Autoantibodies to phospholipids and brain extract in patients with the guillain-barre syndrome: cross-reactive or pathogenic? Autoimmunity. 1993;16:23–44.CrossRef Gilburd B, Stein M, Tomer Y, Tanne D, Abramski O, Chapman Y, et al. Autoantibodies to phospholipids and brain extract in patients with the guillain-barre syndrome: cross-reactive or pathogenic? Autoimmunity. 1993;16:23–44.CrossRef
131.
go back to reference • Santos MSF, De Carvalho JF, Brotto M, Bonfa E, Rocha FAC. Peripheral neuropathy in patients with primary antiphospholipid (Hughes) syndrome. Lupus. 2010;19(5):583–90. https://doi.org/10.1177/0961203309354541A cohort of 26 consecutive patients with primary APS with clinical and electrophysiologic characterization of peripheral nerve involvement.CrossRefPubMed • Santos MSF, De Carvalho JF, Brotto M, Bonfa E, Rocha FAC. Peripheral neuropathy in patients with primary antiphospholipid (Hughes) syndrome. Lupus. 2010;19(5):583–90. https://​doi.​org/​10.​1177/​0961203309354541​A cohort of 26 consecutive patients with primary APS with clinical and electrophysiologic characterization of peripheral nerve involvement.CrossRefPubMed
135.
go back to reference •• Cohen H, Hunt BJ, Efthymiou M, et al. Rivaroxaban versus warfarin to treat patients with thrombotic antiphospholipid syndrome, with or without systemic lupus erythematosus (RAPS): a randomised, controlled, open-label, phase 2/3, non-inferiority trial. Lancet Haematol. 2016;3(9):e426–36. https://doi.org/10.1016/S2352-3026(16)30079-5A randomized, controlled, open-label, non-inferiority trial that failed to show non-inferiority of rivaroxaban compared to warfarin.CrossRefPubMedPubMedCentral •• Cohen H, Hunt BJ, Efthymiou M, et al. Rivaroxaban versus warfarin to treat patients with thrombotic antiphospholipid syndrome, with or without systemic lupus erythematosus (RAPS): a randomised, controlled, open-label, phase 2/3, non-inferiority trial. Lancet Haematol. 2016;3(9):e426–36. https://​doi.​org/​10.​1016/​S2352-3026(16)30079-5A randomized, controlled, open-label, non-inferiority trial that failed to show non-inferiority of rivaroxaban compared to warfarin.CrossRefPubMedPubMedCentral
136.
go back to reference • Pengo V, Denas G, Zoppellaro G, et al. Rivaroxaban vs warfarin in high-risk patients with antiphospholipid syndrome. Blood. 2018;132(13):1365–71. https://doi.org/10.1182/blood-2018-04-848333A trial that associated the use of rivaroxaban in high-risk patients with antiphospholipid syndrome with an increased rate of events compared with warfarin, thus showing no benefit and excess risk.CrossRefPubMed • Pengo V, Denas G, Zoppellaro G, et al. Rivaroxaban vs warfarin in high-risk patients with antiphospholipid syndrome. Blood. 2018;132(13):1365–71. https://​doi.​org/​10.​1182/​blood-2018-04-848333A trial that associated the use of rivaroxaban in high-risk patients with antiphospholipid syndrome with an increased rate of events compared with warfarin, thus showing no benefit and excess risk.CrossRefPubMed
139.
go back to reference • Woller SC, Stevens SM, Kaplan DA, et al. Apixaban for the secondary prevention of thrombosis among patients with antiphospholipid syndrome: study rationale and design (ASTRO-APS). Clin Appl Thromb Off J Int Acad Clin Appl Thromb. 2016;22(3):239–47. https://doi.org/10.1177/1076029615615960Ongoing trial on apixaban for secondary prevention of thrombosis in APS.CrossRef • Woller SC, Stevens SM, Kaplan DA, et al. Apixaban for the secondary prevention of thrombosis among patients with antiphospholipid syndrome: study rationale and design (ASTRO-APS). Clin Appl Thromb Off J Int Acad Clin Appl Thromb. 2016;22(3):239–47. https://​doi.​org/​10.​1177/​1076029615615960​Ongoing trial on apixaban for secondary prevention of thrombosis in APS.CrossRef
142.
go back to reference Andreoli L, Bertsias GK, Agmon-Levin N, Brown S, Cervera R, Costedoat-Chalumeau N, et al. EULAR recommendations for women’s health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome. Ann Rheum Dis. 2017;76(3):476–85. https://doi.org/10.1136/annrheumdis-2016-209770.CrossRefPubMed Andreoli L, Bertsias GK, Agmon-Levin N, Brown S, Cervera R, Costedoat-Chalumeau N, et al. EULAR recommendations for women’s health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome. Ann Rheum Dis. 2017;76(3):476–85. https://​doi.​org/​10.​1136/​annrheumdis-2016-209770.CrossRefPubMed
143.
go back to reference Sammaritano LR, Bermas BL, Chakravarty EE, Chambers C, Clowse MEB, Lockshin MD, et al. 2020 American College of Rheumatology Guideline for the management of reproductive health in rheumatic and musculoskeletal diseases. Arthritis Care Res. 2020;72(4):461–88. https://doi.org/10.1002/acr.24130.CrossRef Sammaritano LR, Bermas BL, Chakravarty EE, Chambers C, Clowse MEB, Lockshin MD, et al. 2020 American College of Rheumatology Guideline for the management of reproductive health in rheumatic and musculoskeletal diseases. Arthritis Care Res. 2020;72(4):461–88. https://​doi.​org/​10.​1002/​acr.​24130.CrossRef
144.
go back to reference Legault K, Schunemann H, Hillis C, Yeung C, Akl EA, Carrier M, et al. McMaster RARE-Bestpractices clinical practice guideline on diagnosis and management of the catastrophic antiphospholipid syndrome. J Thromb Haemost. June 2018;16:1656–64. https://doi.org/10.1111/jth.14192.CrossRef Legault K, Schunemann H, Hillis C, Yeung C, Akl EA, Carrier M, et al. McMaster RARE-Bestpractices clinical practice guideline on diagnosis and management of the catastrophic antiphospholipid syndrome. J Thromb Haemost. June 2018;16:1656–64. https://​doi.​org/​10.​1111/​jth.​14192.CrossRef
155.
go back to reference Gatto M, Perricone C, Tonello M, Bistoni O, Cattelan AM, Bursi R, et al. Frequency and clinical correlates of antiphospholipid antibodies arising in patients with SARS-CoV-2 infection: findings from a multicentre study on 122 cases. Clin Exp Rheumatol. 2020;38(4):754–9.PubMed Gatto M, Perricone C, Tonello M, Bistoni O, Cattelan AM, Bursi R, et al. Frequency and clinical correlates of antiphospholipid antibodies arising in patients with SARS-CoV-2 infection: findings from a multicentre study on 122 cases. Clin Exp Rheumatol. 2020;38(4):754–9.PubMed
Metadata
Title
Neurologic Manifestations of the Antiphospholipid Syndrome — an Update
Authors
Miguel Leal Rato
Matilde Bandeira
Vasco C. Romão
Diana Aguiar de Sousa
Publication date
01-08-2021
Publisher
Springer US
Published in
Current Neurology and Neuroscience Reports / Issue 8/2021
Print ISSN: 1528-4042
Electronic ISSN: 1534-6293
DOI
https://doi.org/10.1007/s11910-021-01124-z

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