Antiphospholipid antibodies in coronary artery disease: a review.

APAs present a clinical problem that is now recognized to be a significant causative factor of both fatal and nonfatal myocardial infarction as well as other coronary syndromes. Similar to the thrombotic complications of APAs in the cerebrovascular system, the result can be life-threatening or fatal. Correct diagnosis requires a high index of suspicion, especially in patients with known prior thrombotic events and in those who present with myocardial ischemia or infarction without underlying risk factors and at a young age. In these patients an aggressive laboratory evaluation must be performed, including testing for APAs. The treatment of the coronary syndrome must progress along currently accepted approaches, including the aggressive and early use of thrombolytic therapy followed by anticoagulation with heparin, porcine heparin, or possibly low molecular weight heparin. Intermediate and long-term therapy with some form of heparin or high-intensity warfarin anticoagulation is essential to have any chance of preventing coronary reocclusion and recurrent myocardial infarction as well as other thrombotic events. Although the precise incidence of APAs in the general and coronary artery disease population is not known and although in the individual patient early disease may be difficult to detect, an enhanced awareness of the possibility of the association of APAs with coronary artery disease may allow earlier diagnosis and may save lives. Studies of larger numbers of patients over extended time periods with various pharmacological approaches to anticoagulation are needed to define more clearly optimal management.