Stroke in patients with systemic lupus erythematosus and antiphospholipid antibody syndrome

Opinion statement  Primary prevention of strokes in patients with antiphospholipid antibodies (APLs) with or without systemic lupus erythematosus (SLE) is not well known. The same applies to patients with SLE and valvular heart disease. The decision should be made on an individual basis until further studies become available. Special consideration for preventive antithrombotic treatment should be given to patients with persistent high titers of immunoglobulin G APLs, which require protein cofactor for detection, presence of lupus anticoagulant, or left-sided cardiac valve lesions. High-level oral anticoagulation with warfarin is still the preferred treatment for secondary prevention of strokes in patients with antiphospholipid antibody syndrome (APS) with or without SLE or with cardiac valvular lesions. Immunosuppression should only be used in patients with active SLE disease. There is no evidence so far to support its use in patients with primary APS. Advances in identifying unique APL features that are associated with increased risk for thrombosis will hopefully allow a more rational treatment for primary and secondary prevention of strokes in these patients in the near future.