- Diagnostic Criteria for APLS: Need ONE lab criteria (confirmed 12 weeks apart) and ONE clinical criteria.
- LAB Criteria: B2 Glycoprotein, Anti-Cardiolipin antibody, or lupus anticoagulant (as measured by prolonged DRVVT which does not correct with a mixing study)
- CLINICAL Criteria: Any Thrombosis (venous/arterial) OR fetal loss/miscarriage
- APLS can be a primary disorder or secondary to other disease (usually Lupus)
- Clinical Features of APLS: 50% have prolonged PTT, 20% with livedo reticularis, cardiac valvular disease (MR), 32% DVT, 13% stroke, 7% hemolytic anemia
- Massive PE refers to PE causing hemodynamic instability (SBP < 90) while submassive PE refers to PE causing right heart strain without hypotension
- Right heart strain from PE: Look for signs of right ventricular hypertrophy and dilatation on EKG, Echo. McConnell’s sign on ECHO is RV hypokinesis with apical sparing
The Chief Residents' Blog