Re: anticardiolipin antibodies

Posted By CCF Cardio MD - MTR on February 16, 1998 at 18:44:54:

In Reply to: anticardiolipin antibodies posted by B. Weeks on February 12, 1998 at 19:01:45:







: I am a 38 year old female, 5'4", 175 lbs.  1 1/2 years ago I suffered a TIA with tingling and numbness on the right side of my body and some slurred speech.  At first the doctor thought it was related to stress because my husband has a genetic disease and I worry about the children.  However, after bloodwork revealed an increase in anticardiolipin antibodies he placed me on Coumadin.  My doctor is the cardiologist who saw me at the hospital.  I still have occassional TIA symptoms, however, after a stress test, MRI, MRA, and Cat scans we have been unable to see any indication of the TIA.  MY questions:  Do TIA's always show up on a scan? and should I continue to see a cardiologist for my coumadin monitoring (every 2 weeks) or see a hemotologist.  I should also mention that my first baby died at almost 5 months and had to be taken by DNC.  My cardiologists suggested the problem was probably from the antibody disorder.  I tested negative for Lupus and APLS.
Dear Mrs. Weeks, you describe a clinical sydrome known as a hypercoagulable state of
which increased anticardiolipin antibodies is one of the many subsets.  Your TIA symptoms
1 and 1/2 years ago presumably were related to a transient occlusion of the left carotid
artery which supplies a portion of the brain that controls the right side of the body and
speech.  Since your symptoms were temporary, they were called a Transient Ischemic Attack
where the brain receives an inadequate supply of blood for a short period of time.  
Persistent weakness or lack of sensation in the arms or legs along with difficulty speaking
usually indicates a stroke.  With a stroke, permanent brain damage can result from
insufficient blood supply to the brain.  Usual diagnostic tests for a stroke include
CT and MRI/MRA scans.  CT and MRI scans look at brain tissue to see if there has been any
damage from insufficient blood supply.  MRA scans are a version of an MRI scan where the
blood vessels that supply blood to the brain are imaged to determine if a narrowing or
blockage exists to disrupt blood flow.  The stress test you had done was designed to look
at blood flow to the heart which, if disrupted, can lead to a heart attack that could
be implicated in the etiology of a TIA.
   The two main causes of a TIA are a blood clot or a severe narrowing of one of the
carotid arteries.  Since your MRA was normal, I presume you don't have a narrowing.  With
a hypercoagulable state, you could have formed a blood clot that transiently disrupted
blood flow to your left carotid artery to cause your symptoms.  Thankfully, it sounds
like your body's own "clot busting" system took over and dissolved the clot before brain
tissue damage developed.  With all your tests being negative, I presume that you did not have a stroke.  
Since a TIA is a transient attack without brain damage, nothing should be seen on CT or MRI scan
(as was seen with you).  However, it sounds like you need to continue on coumadin to thin your
blood to prevent recurrent blood clots from developing.  Your cardiologist is certainly
capable of monitoring your coumadin therapy but if you have doubts about your diagnosis
of increased anticardiolipin antibodies,seeing a hematologist would be the next logical step.
   Two good medical review articles that you may find useful on hypercoagulable states
are in the journal Annals of Internal Medicine (#1: Vol. 119 pages 819-827, 1993 / #2:
Vol. 112 pages 682-698, 1990). I hope this information helps.
   Information provided in the Heart Forum is for general purposes only.  Specific advice
and recommendations should be obtained from your regular physician.