Primary antiphospholipid syndrome: indications for long-term anticoagulation.

Primary antiphospholipid syndrome, defined as the presence of antiphospholipid antibodies with recurrent thrombosis in patients who have no clinical or serologic features of systemic lupus erythematosus, is now a medically recognizable and treatable disorder. 1 The syndrome is associated with a high incidence of recurrent arterial and venous occlusions, with cerebrovascular thrombi occurring second in frequency only to deep vein thrombi.2 Current recommendations are to screen for antiphospholipid antibodies in all patients younger than 45 years (even those with risk factors for thromboses) who have had a thrombotic event, as well as in patients who have clinical features of systemic lupus erythematosus or who have had more than two miscarriages.3 The case presented here illustrates the challenge and importance of recognizing primary antiphospholipid syndrome in a family practice.