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(Stroke. 1998;29:1755-1758.)
© 1998 American Heart Association, Inc.

Editorial

Antiphospholipid-Protein Antibodies and Ischemic Stroke

Not Just Cardiolipin Any More

David Tanne, MD; Douglas A. Triplett, MD, FACP, FCAP; Steven R. Levine, MD

From the Center for Stroke Research, Department of Neurology, Henry Ford Hospital and Health Sciences Center, Detroit, Mich (D.T., S.R.L.) and the Midwest Hemostasis and Thrombosis Laboratories, Ball Memorial Hospital, Muncie, Ind (D.A.T.). Dr Tanne is currently at the Department of Neurology, Chaim Sheba Medical Center, Tel Hashomer, Israel.

Correspondence to Steven R. Levine, MD, Director, WSU/Detroit Medical Center Stroke Program, WSU School of Medicine, University Health Center 6E, 4201 St Antoine, Detroit, MI 48201.

Key Words: antibodies, anticardiolipin • antibodies, antiphospholipid • cerebral ischemia

Within the past decade, cerebral infarction in as many as 40% of patients was not found to have a determined cause based on NINCDS Stroke Data Bank criteria.¹ With improved understanding of the complex pathogenic processes leading to ischemic stroke and refined imaging and diagnostic tests, underlying potential causes are more often recognized. Yet, the etiology of ischemic stroke in a discouragingly large number of patients continues to elude clinicians.

Antiphospholipid antibodies (aPL) are a heterogeneous family of autoantibodies associated with a clinical syndrome characterized by thrombo-occlusive events. Anticardiolipin antibodies (aCL), detected by standard enzyme-linked immunosorbent assay (ELISA), and the lupus anticoagulant (LA), which prolongs phospholipid-dependent coagulation assays, are conventional assays for aPL and the ones currently best characterized and standardized.^{2 3} There is partial concordance between the 2 assays. The preponderance of evidence indicates, however, that LA assay is more specific for patients at risk for thromboembolic events.⁴ In contrast, the aCL assay is more sensitive but nonspecific and could be found also in various contexts ranging from health to certain medications, malignancies, and infectious diseases. aCL have been identified in approximately 10% of unselected patients with first ischemic stroke.⁵ The isotype mainly implicated in thrombosis is IgG, more specifically subtype IgG₂.⁶ Recent data suggest that the presence of high titers of aCL immunoreactivity, mainly IgG isotype but possibly also IgM, correlates with an increased risk of thrombosis.^{7 8 9} Generally, titers of IgG aCL implicated are >40 GPL, although this is a somewhat arbitrary cutoff point and is dependent on . . . [Full Text of this Article]

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