Antiphospholipid syndrome (APS), sometimes called Hughes syndrome, is an autoimmune condition in which the immune system produces antibodies that make the blood more likely to clot than normal. It can affect veins, arteries and pregnancy.

• APS can occur on its own (primary APS), or alongside another autoimmune disease, most commonly lupus (secondary APS).
• The hallmark problems are blood clots — in the legs (deep vein thrombosis), lungs (pulmonary embolism), or brain (stroke) — and pregnancy complications such as recurrent miscarriage.
• Because it is driven by specific antibodies detectable on a blood test, APS is one of the more definitively diagnosable rheumatology conditions once suspected.
• With the right blood-thinning treatment, most complications of APS are preventable.

• A blood clot in a leg vein (pain, swelling, warmth, redness — deep vein thrombosis) or in the lungs (sudden breathlessness, chest pain — pulmonary embolism)
• Stroke or mini-stroke symptoms in younger patients without the usual risk factors
• Recurrent early miscarriage, or later pregnancy loss, pre-eclampsia, or poor fetal growth
• A lace-like purplish skin discolouration (livedo reticularis), particularly on the legs
• Low platelet count, sometimes causing easy bruising, found incidentally on blood tests

• APS is an autoimmune disease — the immune system produces antiphospholipid antibodies that interfere with normal blood clotting regulation, tipping the balance towards excess clotting.
• It can develop on its own, or alongside another autoimmune disease, most often systemic lupus erythematosus.
• The exact trigger for antibody production is not fully understood, though genetic susceptibility and, in some cases, infections are thought to play a role.
• It is not caused by lifestyle factors, though smoking and other clotting risk factors can compound the risk in someone who already has APS.

• A detailed history of any blood clots, strokes, or pregnancy complications, and their circumstances.
• Blood tests for antiphospholipid antibodies — lupus anticoagulant, anticardiolipin antibodies, and anti-beta-2-glycoprotein I antibodies — usually repeated 12 weeks apart to confirm a persistent result.
• Screening for an underlying lupus or other autoimmune disease, since APS often coexists with these conditions.
• Imaging as needed to confirm and characterise any blood clots that have already occurred.

Blood-thinning medication

For patients who have already had a clot, long-term anticoagulation (blood thinners, most often warfarin, carefully monitored) is the mainstay of treatment to prevent further clotting events.

Low-dose aspirin for prevention

In patients with antiphospholipid antibodies but no clot yet, or during pregnancy, low-dose aspirin — sometimes combined with a different blood thinner during pregnancy — is used to reduce risk.

Specialist pregnancy planning

For women with APS planning a pregnancy, a carefully coordinated treatment plan between rheumatology and obstetrics significantly improves the chance of a successful, full-term pregnancy.

Managing an underlying autoimmune disease

If APS occurs alongside lupus or another autoimmune condition, treating that underlying disease is an important part of the overall management plan.

Consultations with the OARC rheumatology team run Monday to Saturday, 9:00 AM–2:00 PM and 4:30–9:00 PM. Call +91 93386 53086 or book online.

• With appropriate blood-thinning treatment, most people with APS can prevent further clotting events and live a normal, active life.
• Coordinated care between rheumatology and obstetrics has dramatically improved pregnancy outcomes for women with APS over the past two decades.
• APS needs lifelong monitoring and, in most cases, lifelong blood-thinning treatment — stopping treatment without medical guidance can be dangerous.