Abstract
A 65-year-old man suffering from repeated cerebral infarction acquired an ulcer on the right leg. His serological results were positive for anti-β2-glycoprotein I antibody and lupus anticoagulant ; thus, he was suspected to have antiphospholipid syndrome (APS). Because peripheral blood vessel occlusion was observed by contrasting computed tomography (CT), the control of thrombosis by rivaroxaban was suspected to be poor. Therefore, rivaroxaban was switched to warfarin. One day after the introduction of warfarin, his level of consciousness deteriorated, and CT revealed a hematoma on his right lateral ventricle. Magnetic resonance imaging showed a poor depiction of the right middle cerebral artery, suggesting an hemorrhagic infarction. We speculated that the destructive autoimmune effect of the antiphospholipid antibody induced repeated cerebral infarction, aortic thrombosis, and leg ulcer even with extensive anti-coagulatory therapy. Current guidelines recommend anticoagulant therapy in conjunction with warfarin and antiplatelet therapy with aspirin to prevent thrombosis by APS. However, reported cases including the one reported here indicate that anticoagulant therapy alone is insufficient to prevent thrombosis in APS, and new breakthroughs in the treatment of APS are needed in the future.
