Management of Thrombosis in Women With Antiphospholipid Syndrome

Abstract

1) Antiphospholipid antibody syndrome may be associated with unusual sites of thrombosis. 2) Laboratory evaluation involves testing for antiphospholipid antibodies: lupus anticoagulant and anticardiolipin antibodies. 3) Acute management of thrombosis involves immediate anticoagulation. Low-molecular-weight heparins are as safe and effective as unfractionated heparin in this setting. Arterial events may require emergent thrombolytic therapy. Monitoring of the APTT with unfractionated heparin in the presence of a lupus anticoagulant is ineffective; these patients require monitoring of antifactor Xa levels or the use of LMWH, which does not require monitoring. 4) The pharmacokinetics of LMWH change in pregnancy, resulting in a shorter plasma half-life and larger volume of distribution. Monitoring of antifactor Xa levels is necessary. 5) Chronic anticoagulation is best achieved with warfarin, with significantly decreased rates of recurrent events when the INR is > or = 3.0. Long-term, if not life-long, anticoagulation is often necessary. Warfarin is teratogenic, and individuals desiring pregnancy will need to convert to therapeutic, not prophylactic, doses of either unfractionated heparin or LMWH. 6) As part of optimal management of thrombosis in APS, additional risk factors for thrombosis should be eliminated or reduced. These include comorbid illnesses such as hypertension and hyperlipidemia, as well as smoking. 7) Tamoxifen, raloxifene, oral contraceptives, and hormone replacement therapy are all associated with an increased risk of DVT in the general population. In APS patients receiving therapeutic anticoagulation, the addition of these drugs should not increase thrombosis risk. In APS patients not receiving anticoagulant therapy, these hormonal therapies may increase the thrombosis risk.

Plasma ADAMTS13, von Willebrand Factor (VWF), and VWF Propeptide Profiles in Patients With Connective Tissue Diseases and Antiphospholipid Syndrome

“…1 Antiphospholipid antibody syndrome (APS) 2,3 is a well-known systemic thrombotic diathesis that is associated with the presence of antiphospholipid antibodies (aPLs). The mechanisms underlying the development of thrombosis, including cerebral thrombosis 4 and VTE, 5 and obstetric morbidity 6 due to aPLs are poorly understood. Antiphospholipid antibody syndrome consists of the primary APS and secondary APS.…”

Anticorpos antifosfolípides em mulheres com antecedentes de perdas gestacionais: estudo caso-controle

“…A freqüência dos aPL (AL e/ou aCL IgG e/ou IgM) observada no presente estudo foi de 17% em mulheres com gestações bem sucedidas e de 28% naquelas com antecedentes de perdas gestacionais, enquanto na literatura esses números variam de 2% a 14% na população obstétrica em geral (10,15) , e de 20% a 40%, nas mulheres com insucesso reprodutivo (10,16) . Essa variação na freqüência desses anticorpos pode se dever, dentre outras razões, ao fator racial.…”

The relation between antiphospholipid syndrome-related pregnancy morbidity and non-gravid vascular thrombosis: A review of the literature and management strategies

“…Barbour et al [35] demonstrated that prophylactic doses of heparin are inadequate for thromboembolism prophylaxis and heparin requirements may increase during pregnancy, and suggested that plasma anti-factor Xa activity should guide the therapy. There are reports supporting and questioning the role of anti-factor Xa monitoring for heparin [35][36][37].…”