Antiphospholipid syndrome secondary prevention

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 (APS) includes reduction of reversible risk factors such as smoking, hypertension, hyperlipidemia and life-long anticoagulation maintaining a target INR of 3.0-4.0

Secondary Prevention

Reduction of reversible risk factors

The following risk factors should be controlled for the secondary prevention of APS:^[1]^[2]^[3]

Oral contraceptives use
Smoking
Hypertension
Hyperlipidemia
During the perioperative period, this may include minimizing the period when patients are off anticoagulation.
Initiating early ambulation
Measures to reduce venous stasis.

Continuation of anticoagulation:

For patients with APS and a history of an unprovoked thrombotic event, lifelong anticoagulation is recommended.^[1]^[2]^[3]

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

References

↑ ^1.0 ^1.1 Ruiz-Irastorza G, Cuadrado MJ, Ruiz-Arruza I, Brey R, Crowther M, Derksen R; et al. (2011). “Evidence-based recommendations for the prevention and long-term management of thrombosis in antiphospholipid antibody-positive patients: report of a task force at the 13th International Congress on antiphospholipid antibodies”. Lupus. 20 (2): 206–18. doi:10.1177/0961203310395803. PMID 21303837.
↑ ^2.0 ^2.1 Holbrook A, Schulman S, Witt DM, Vandvik PO, Fish J, Kovacs MJ; et al. (2012). “Evidence-based management of anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines”. Chest. 141 (2 Suppl): e152S–e184S. doi:10.1378/chest.11-2295. PMC 3278055. PMID 22315259.
↑ ^3.0 ^3.1 Keeling D, Mackie I, Moore GW, Greer IA, Greaves M, British Committee for Standards in Haematology (2012). “Guidelines on the investigation and management of antiphospholipid syndrome”. Br J Haematol. 157 (1): 47–58. doi:10.1111/j.1365-2141.2012.09037.x. PMID 22313321.

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[pmid21303837-1] 1.0 ^1.1 Ruiz-Irastorza G, Cuadrado MJ, Ruiz-Arruza I, Brey R, Crowther M, Derksen R; et al. (2011). “Evidence-based recommendations for the prevention and long-term management of thrombosis in antiphospholipid antibody-positive patients: report of a task force at the 13th International Congress on antiphospholipid antibodies”. Lupus. 20 (2): 206–18. doi:10.1177/0961203310395803. PMID 21303837.

[pmid22315259-2] 2.0 ^2.1 Holbrook A, Schulman S, Witt DM, Vandvik PO, Fish J, Kovacs MJ; et al. (2012). “Evidence-based management of anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines”. Chest. 141 (2 Suppl): e152S–e184S. doi:10.1378/chest.11-2295. PMC 3278055. PMID 22315259.

[pmid22313321-3] 3.0 ^3.1 Keeling D, Mackie I, Moore GW, Greer IA, Greaves M, British Committee for Standards in Haematology (2012). “Guidelines on the investigation and management of antiphospholipid syndrome”. Br J Haematol. 157 (1): 47–58. doi:10.1111/j.1365-2141.2012.09037.x. PMID 22313321.

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