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
Secondary Prevention
Long term anticoagulation
Anticoagulation for venous thrombosis:
Anticoagulation for arterial thrombosis:
For patients having definite diagnosis of antiphospholipid syndrome (APS) and previous history of arterial thrombosis are treated with warfarin and low dose aspirin.
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 |
Patients with definite antiphospholipid syndrome and first venous event* Patients with definite antiphospholipid syndrome and recurrent events despite warfarin with a target intensity of 2·0–3·0 Patients with arterial thrombosis with single positive or low-titre antiphospholipid antibodies Secondary prophylaxis Indefinite anticoagulation to a target INR 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 As per usual recommendations for arterial thrombosis Patients with definite antiphospholipid syndrome and arterial event* Indefinite anticoagulation to a target INR 3·0–4·0 or combined antithrombotic treatment Patients with venous thromboembolism with single positive or low-titre antiphospholipid antibodies As per usual recommendations for deep vein thrombosis treatment INR=international normalised ratio. *Less aggressive or long-lasting antithrombotic treatments might be appropriate in low-risk patients.