Current status and implications of autoimmune antiphospholipid antibodies in relation to thrombotic disease

This review briefly describes the development of the concepts of anti phospholipid antibody and of antiphospholipid syndrome. It focuses on the two main antigenic targets, beta(2) glycoprotein I and prothrombin. An excessive production of natural antibodies rather than an immune response to exogenous antigen is proposed as pathogenetic for the development of these antibodies. The review attempts to explain how some of these antibodies are anticoagulant in vitro yet prothrombotic in vivo. The final section discusses when to test for such antibodies, how to test and how to consider treatment of patients with the antiphospholipid syndrome.