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