Hemostasis Today
NewsFeed
Headlines Hematology Health Medicine VTE ASH Plasma Donation
October, 2026
October 2026
M T W T F S S
 1234
567891011
12131415161718
19202122232425
262728293031  
Francisco Chacón-Lozsán: Catastrophic Antiphospholipid Syndrome A Rapidly Progressive Multiorgan Thrombotic Emergency
Francisco Chacón-Lozsán/LinkedIn
Oct 12, 2026, 13:58

Francisco Chacón-Lozsán: Catastrophic Antiphospholipid Syndrome A Rapidly Progressive Multiorgan Thrombotic Emergency

Francisco Chacón-Lozsán, Fellow at World Extreme Medicine, Member of European Society of Intensive Care Medicine (ESICM) and American College of Cardiology, shared a post on LinkedIn about recent articles:

“Critical Physiology Series 93

Catastrophic Antiphospholipid Syndrome

A patient develops acute kidney injury, respiratory failure, neurological dysfunction and thrombocytopenia within days.

Sepsis? DIC? TTP?

Consider also catastrophic antiphospholipid syndrome (CAPS).

Pathophysiology

CAPS is a rare, life threatening manifestation of antiphospholipid syndrome characterized by rapidly progressive thrombosis, predominantly affecting the microcirculation.

Antiphospholipid antibodies, particularly those targeting β2 glycoprotein I, activate endothelial cells, monocytes and platelets.

Antibody binding lead to complement activation lead to endothelial dysfunction lead to tissue factor expression lead to thrombin generation

Neutrophil extracellular traps and inflammatory mediators amplify thrombosis.

The result:

microvascular occlusion lead to tissue ischemia lead to organ dysfunction

Unlike isolated venous thromboembolism, CAPS may simultaneously damage kidneys, lungs, brain, heart and other organs.

Risk factors and triggers

CAPS may develop in established APS or be its first manifestation.

Important associations include:

systemic lupus erythematosus, previous thrombosis and high risk antiphospholipid antibody profiles.

Common triggers:

infection, surgery, trauma, pregnancy complications and interruption of anticoagulation.

Diagnosis

Suspect CAPS when thrombosis and organ dysfunction develop rapidly across multiple systems.

Classical classification criteria include:

higher 3 organs involved
manifestations within approximately one week
small vessel thrombosis on histology
positive antiphospholipid antibodies

However, incomplete criteria do not exclude probable CAPS.

Request:

lupus anticoagulant
anticardiolipin IgG or IgM
anti-β2-glycoprotein I IgG or IgM

Interpret testing cautiously during acute illness and anticoagulation.

Differentiate CAPS from DIC, TTP or HUS, HIT and sepsis associated microangiopathy.

Monitoring

Follow:

platelets and hemolysis markers
PT aPTT, fibrinogen
creatinine, urine output
lactate and organ perfusion
ECG, troponin, echocardiography
neurological and respiratory function

Management

CAPS requires urgent multidisciplinary treatment, often before complete diagnostic confirmation.

The conventional approach combines:

Therapeutic heparin lead to suppress ongoing thrombosis

High dose corticosteroids lead to suppress inflammation

Plasma exchange and or IVIG lead to modulate pathogenic immune activity

Treat the precipitating infection or other trigger.

In SLE associated CAPS, cyclophosphamide may be indicated.

Refractory cases may require rituximab or complement inhibition with eculizumab in selected circumstances.

Evidence remains largely observational because randomized trials are lacking.

Recommended lectures.”

Title 1: Diagnosis and Management of Catastrophic Antiphospholipid Syndrome and the Potential Impact of the 2023 ACR/EULAR Antiphospholipid Syndrome Classification Criteria

Authors: Lucas Jacobs, Nader Wauters, Yahya Lablad, Johann Morelle, Maxime Taghavi

Read Full Article on MDPI.

Francisco Chacón-Lozsán: Catastrophic Antiphospholipid Syndrome A Rapidly Progressive Multiorgan Thrombotic Emergency

Title 2: Antiphospholipid syndrome pathogenesis in 2023: an update of new mechanisms or just a reconsideration of the old ones?

Authors: Elena Raschi, Maria Orietta Borghi, Francesco Tedesco, Pier Luigi Meroni

Read Full Article on Rheumatology.

Francisco Chacón-Lozsán: Catastrophic Antiphospholipid Syndrome A Rapidly Progressive Multiorgan Thrombotic Emergency

Title 3: McMaster RARE‐Bestpractices clinical practice guideline on diagnosis and management of the catastrophic antiphospholipid syndrome

Authors: K. Legault, H. Schunemann, C. Hillis, C. Yeung, E.A. Akl, M. Carrier, R. Cervera, M. Crowther, F. Dentali, D. Erkan, G. Espinosa, M. Khamashta, J.J. Meerpohl, K. Moffat, S. O’Brien, V. Pengo, J.H. Rand, I. Rodriguez Pinto, L. Thom, A. Iorio

Read Full Article on Ovid.

Francisco Chacón-Lozsán: Catastrophic Antiphospholipid Syndrome A Rapidly Progressive Multiorgan Thrombotic Emergency

Title 4: Treatment of catastrophic antiphospholipid syndrome

Authors: Nayef M. Kazzaz, W. Joseph McCune, Jason S. Knight

Read Full Article on JTH.

Francisco Chacón-Lozsán: Catastrophic Antiphospholipid Syndrome A Rapidly Progressive Multiorgan Thrombotic Emergency

Stay updated on all scientific advances with Hemostasis Today.

A. Iorio C. Hillis C. Yeung D. Erkan E.A. Akl Elena Raschi F. Dentali Francesco Tedesco Francisco Chacón-Lozsán G. Espinosa H. Schunemann Health Hematology Hemostasis Hemostasis News Hemostasis Today I. Rodriguez Pinto J.H. Rand J.J. Meerpohl Jason S. Knight Johann Morelle K. Legault K. Moffat L. Thom Lucas Jacobs M. Carrier M. Crowther M. Khamashta Maria Orietta Borghi Maxime Taghavi Medicine Nader Wauters Nayef M. Kazzaz Pier-Luigi Meroni R. Cervera S. O'Brien V. Pengo W. Joseph McCune Yahya Lablad
NewsFeed