A 39-year-old man with a history of ischemic stroke 10 years ago presented after 1 day of right calf swelling and shortness of breath. He reported no trauma, surgery, recent prolonged mobility limitation, or family history of thrombosis. His only medication was aspirin, 81 mg daily. On examination, his heart rate was 106/min, respiratory rate was 28/min, and swelling of the right calf was noted. A heparin drip was initiated for suspected pulmonary embolism, which was confirmed with computed tomography pulmonary angiography. Routine laboratory values were unremarkable. Warfarin was administered for long-term anticoagulation. Given the unprovoked thrombotic events at a young age, a hypercoagulable state was suspected, and testing for the antiphospholipid syndrome was performed. Two days later, results revealed elevated titers of anticardiolipin and anti–β2 glycoprotein I antibodies and negative lupus anticoagulant screening assays (Table 1).
Gupta A, Johnson DH, Nagalla S. Antiphospholipid Antibodies. JAMA. 2017;318(10):959–960. doi:10.1001/jama.2017.4854