Antiphospholipid Syndrome (APS) and CNS Lupus: Anticoagulation Treatment By Prof Graham Hughes

Posted on: May 29, 2020
Last Updated: October 18, 2020

Professor Graham Hughes is a Consultant Rheumatologist and the founder and editor of the international journal LUPUS,’ and Head of London Lupus Centre. In 1983 he described the clotting disorder now known as Hughes Syndrome for which he received the World Rheumatology (ILAR) Research Prize in 1993. 

Author Quotes  

My prediction is that the antiphospholipid syndrome may well become recognized as the most important cause of CNS Lupus.

The brain is very sensitive to circulation problems – more so than we’ve ever perhaps fully realised and I think every aspect of neurology is seen. I think the diagnosis is truly often missed, and I think treatment certainly in our experience results in marked improvement.


Professor Hughes begins this presentation with the question of why the brain is so involved in APS and discusses how the clotting system in the brain is different. 

A discussion of anticoagulant treatments focuses on low molecular heparin injection and how that can either have no effect, or a striking effect in patients with APS. 

Providing data from a patient study, he demonstrates the rapid improvement in memory over a 4-week treatment period and goes on to discuss how APS of the brain is undertreated.  

 Prof Hughes also highlights the importance of self-testing of patients, to keep track of INR levels explaining how this can be done just as easily for anticoagulation as it is for diabetes. 

Concluding this presentation, Prof Hughes emphasizes how treating a patient for APS rather than Lupus requires an alternative approach. He summarises the brain’s sensitivity to circulation, missed diagnoses, and the improvements seen with treatment. 

Take-Home Points  

  • Hughes Syndrome is identified through clotting or sludging, not bleeding. 
  • APS of the brain is undertreated. 
  • Anticoagulant or antiplatelet therapy is an alternative to steroid treatment.


Learn more

  1. Antiphospholipid Syndrome (APS) Case Files (Stillbirths and Epilepsy) By Prof Graham Hughes
  2. Antiphospholipid Syndrome (APS) Case Files (Stroke and Thrombosis) By Prof Graham Hughes
  3. Antiphospholipid Syndrome (APS) Case Files (Gut, Tinnitus and Migraine) – Prof Graham Hughes
  4. Antiphospholipid Syndrome (APS):The Clinical Experience – Dr. Graham Hughes
  5. Antiphospholipid Syndrome : 30 Years On – Dr. Graham Hughes
  6. Central Nervous System (CNS) Involvement in Antiphospholipid (Hughes) Syndrome – Prof Graham Hughes
  7. Clues to the Diagnosis of Antiphospholipid Syndrome – Prof Graham Hughes
  8. Neuropsychiatric Lupus and The Curious Case of Molly – What Does This Case Teach Us? – Prof Hughes
  9. Pathogenesis of Neuropsychiatric Systemic Lupus Erythematosus – Prof Graham Hughes
  10. What is Lupus? – Prof Graham Hughes
  11. Prof Graham Hughes Introduces You To The World of Lupus and Antiphospholipid Syndrome – Prof Graham Hughes
  12. Neuropsychiatric Manifestations in APS By Prof Graham Hughes
  13. Q & A session on Lupus, Hughes Syndrome and the Brain – Prof Hughes


  1. Hughes GR. Heparin, antiphospholipid antibodies and the brain. Lupus. 2012;21(10):1039-1040.
  2. Whitelaw DA, Spangenberg JJ. An investigation in the possible effect of chronic headache on neuropsychological function in aCL-negative patients with SLE. Lupus. 2009;18(7):613-617.