The two hit hypothesis in the antiphospholipid syndrome: acute ischaemic heart involvement after valvular replacement despite anticoagulation in a patient with secondary APS
Abstract
A patient with the antiphospholipid syndrome (APS), in whom a nonfatal myocardial infarction ensued after valvular heart replacement despite anticoagulation, is described. The report further stresses the role of concomitant risk co-factors in inducing thrombotic events and points out that cardiosurgery might represent a potential major risk for myocardial ischaemic damage in APS.
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Antiphospholipid antibodies contribute actively to the development of antiphospholipid syndrome.
“Antiphospholipid antibodies (aPL Abs) play an active role in the pathogenesis of the antiphospholipid syndrome (APLS).”
Antiphospholipid antibodies by themselves are insufficient for thrombosis and can remain for a long period before a second hit triggers the thrombotic event.
“However, aPL Abs alone are not sufficient, and may persist for a long time before the 2nd hit results in the actual thrombotic event (1, 2).”
Under the two-hit hypothesis, antiphospholipid antibodies are required for a prothrombotic state.
“According to the two-hit hypothesis, the presence of antiphospholipid antibodies (aPL Abs) is necessary to create a prothrombotic state (1st hit).”
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References 8 · Cited by 33
- Authors
- Bordin, G., Boldorini, R., & Meroni, P. L.
- Affiliations
- Ospedale Bassini (IT)
- Azienda Ospedaliero Universitaria Maggiore della Carita (IT)
- University of Milan (IT)
- Corresponding author
- Bordin, G
- Venue
- Lupus
- Publisher
- SAGE Publications
- Published
- 2003-11
- Volume
- 12
- Issue
- 11
- Pages
- 851-853
- ISSN
- 0961-2033 (ISSN-L)
- 1477-0962
- OpenAlex
- W2137739728
- Cited by
- 33
- References
- 8
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 1 · 2022: 1 · 2021: 2 · 2020: 5 · 2019: 2 · 2018: 1 · 2017: 1 · 2016: 2 · 2015: 1 · 2014: 1 · 2013: 4 · 2012: 3
- FWCI
- 0.39
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Lupus (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac tumors and thrombi
- Health Sciences › Medicine › Surgery › Heparin-Induced Thrombocytopenia and Thrombosis
- Keywords
- antiphospholipid syndrome, two-hit hypothesis, secondary antiphospholipid syndrome, myocardial infarction, heart valve replacement, anticoagulation, thrombosis, cardiac surgery
- MeSH terms
- Abortion, Spontaneous, Anticoagulants, Extracorporeal Circulation, Female, Heart Arrest, Induced, Humans, Middle Aged, Mitral Valve, Mitral Valve Insufficiency, Myocardial Infarction, Postoperative Complications, Risk Factors, Antiphospholipid Syndrome, Thrombophilia, Heart Valve Prosthesis Implantation
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