Antiphospholipid Syndrome as an Under-Recognized Cause of Ischemic Stroke in Older Adults: A Retrospective Case Series.
- 1Department of Neurology, University of South Dakota Sanford School of Medicine, Sioux Falls, USA.
- 2Neurology, Maternity and Children Hospital, Hofuf, SAU.
Abstract
Background, objective, and methods: Antiphospholipid syndrome (APS) is classically regarded as a cause of thrombosis and stroke in younger patients and is often considered a rare etiology beyond the sixth decade. We retrospectively describe seven older adults (ages 67-90 years; median 76; four females) with ischemic stroke in whom antiphospholipid antibodies (aPL) were identified during evaluation, most after one or more cerebrovascular events. Results: Six of the seven had radiographic or clinical evidence of prior cerebrovascular disease, and several had experienced recurrent events despite antiplatelet or anticoagulant therapy. Antibody profiles were heterogeneous, ranging from triple positivity with confirmed persistence to isolated lupus anticoagulant and IgM-only positivity, and competing stroke mechanisms (patent foramen ovale, large-artery atherosclerosis, and small-vessel disease) were frequently present. All patients were transitioned to a vitamin K antagonist. Conclusions: This series illustrates that aPL-associated stroke does occur in older adults and supports considering APS in the differential of cryptogenic or recurrent ischemic stroke in this population, while underscoring the need for high-specificity, persistently confirmed testing before committing a patient to lifelong anticoagulation.
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BibTeX
@article{razavi2026antiphospholipid,
title = {{Antiphospholipid Syndrome as an Under-Recognized Cause of Ischemic Stroke in Older Adults: A Retrospective Case Series.}},
author = {Seyed Mostafa Razavi and Mahika Khurana and Mariami Gabadadze and Balaganesh Natarajan and Poojitha Sushma Malla and Eman Elmasry Eldamarany Khalifa and Ahmed Abd Elazim},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.116600},
url = {https://europepmc.org/article/MED/42904261},
note = {CC BY},
}
RIS
TY - JOUR
TI - Antiphospholipid Syndrome as an Under-Recognized Cause of Ischemic Stroke in Older Adults: A Retrospective Case Series.
AU - Seyed Mostafa Razavi
AU - Mahika Khurana
AU - Mariami Gabadadze
AU - Balaganesh Natarajan
AU - Poojitha Sushma Malla
AU - Eman Elmasry Eldamarany Khalifa
AU - Ahmed Abd Elazim
PY - 2026
DA - 2026/09/20
JO - Cureus
DO - 10.7759/cureus.116600
UR - https://europepmc.org/article/MED/42904261
AB - Background, objective, and methods: Antiphospholipid syndrome (APS) is classically regarded as a cause of thrombosis and stroke in younger patients and is often considered a rare etiology beyond the sixth decade. We retrospectively describe seven older adults (ages 67-90 years; median 76; four females) with ischemic stroke in whom antiphospholipid antibodies (aPL) were identified during evaluation, most after one or more cerebrovascular events. Results: Six of the seven had radiographic or clinical evidence of prior cerebrovascular disease, and several had experienced recurrent events despite antiplatelet or anticoagulant therapy. Antibody profiles were heterogeneous, ranging from triple positivity with confirmed persistence to isolated lupus anticoagulant and IgM-only positivity, and competing stroke mechanisms (patent foramen ovale, large-artery atherosclerosis, and small-vessel disease) were frequently present. All patients were transitioned to a vitamin K antagonist. Conclusions: This series illustrates that aPL-associated stroke does occur in older adults and supports considering APS in the differential of cryptogenic or recurrent ischemic stroke in this population, while underscoring the need for high-specificity, persistently confirmed testing before committing a patient to lifelong anticoagulation.
SN - 2168-8184
ER -