Antiphospholipid syndrome secondary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Feham Tariq, MD [2]

Overview

The secondary prevention of antiphospholipid syndrome includes reduction of reversible risk factors and life-long anticoagulation maintaining a target INR of 3.0-4.0

Secondary Prevention

Reduction of reversible risk factors

During the perioperative period, this may include minimizing the period when patients are off anticoagulation, initiating early ambulation, and other measures to reduce venous stasis.

Continuation of anticoagulation:

For patients with APS and a history of an unprovoked thrombotic event, lifelong anticoagulation is recommended.

Recommendations for secondary prophylaxis in patients with antiphospholipid antibodies and thrombosis
Patients with definite antiphospholipid syndrome and first venous event	Indefinite anticoagulation to a target INR* 2·0–3·0
Patients with definite antiphospholipid syndrome and arterial event	Indefinite anticoagulation to a target INR 3·0–4·0
Patients with definite antiphospholipid syndrome and recurrent events despite warfarin with a target intensity of 2·0–3·0	Indefinite anticoagulation to a target INR 3·0–4·0 or alternative therapies such as extended therapeutic dose low-molecular-weight heparin
Patients with venous thromboembolism with single positive or low-titre antiphospholipid antibodies	As usual per recommendations for deep vein thrombosis treatment
Patients with arterial thrombosis with single positive or low-titre antiphospholipid antibodies	As usual per recommendations for arterial thrombosis

*INR= International normalized ratio