PREVALENCE AND PATHOLOGY OF VASCULAR OCCLUSIVE DISEASE IN THE ANTIPHOSPHOLIPID SYNDROMES

Vascular occlusive disease occurs not infrequently in patients with an tiphospholipid syndromes (APS) and, in some, may be associated with ca tastrophic complications. Recurrent, large- and small-vessel, arterial and/or venous thrombosis, and not vasculitis, is the only known and p roven pathologic basis of virtually all clinical manifestations of APS in systemic, pulmonary, and/or cerebral circulations. Whether the vas culopathy of APS is thrombosis or vasculitis is of more than mere acad emic interest; the distinction is important not only for unravelling t he pathogenesis of vascular injuries in APS but also for making the co rrect choice of drug treatment. A diagnosis of vasculitis would call f or treatment with immunosuppressive and cytotoxic agents replete with undesirable and serious side effects. Furthermore, these powerful, but potentially dangerous, drugs are quite ineffectual in resolving or pr eventing the thrombosis associated with APS, which has been demonstrat ed clinically to respond to the lowly and inexpensive aspirin. (C) 199 7 by Elsevier Science, Inc.