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Lim W, Crowther MA, Eikelboom JW. Management of antiphospholipid antibody syndrome. A systematic review. JAMA 2006; 295:1050–1057

from the Rare Thrombotic Diseases Consortium

August 20, 2005

This link contains full news articles and many up to date medical journal abstracts dealing with APS and its related diseases. Free Registration is required.

Natl Med J India. 2003 Nov-Dec;16(6):311-6. Promotes an INR of 3-4.

Michael D. Lockshin, MD Attending Rheumatologist, Hospital for Special Surgery Professor of Medicine, Weill Cornell Medical College Director, Barbara Volcker Center for Women and Rheumatic Disease. In this presentation, Dr. Lockshin provides an explanation of antiphospholipid syndrome (APS) and how it can be treated. He then answers questions submitted by patients in attendance.

Am J Med. 1994 Jan;96(1):3-9.

Antiphospholipid syndrome (APS) is characterized by the following: venous or arterial thrombosis--a condition where clots, called thrombi, form in the blood vessels; recurrent miscarriages--the repeated loss of the fetus in pregnancies; and thrombocytopenia--a low number of blood platelets that can lead to bleeding, seen as bruising and tiny red dots on the skin. Medical College of Wisconsin.

Supports an INR of 3.0 to 4.0 for APS patients.

(APS) is a term used to describe the association between recurrent clinical events such as thrombosis (arterial or venous), thrombocytopenia, or fetal loss and the presence of a persistent antiphospholipid antibody 1-3. Other clinical conditions associated with the syndrome include stroke, transient ischemic attack, livedo reticularis, migraine, epilepsy, and heart valve disease4. The syndrome is termed "primary" if there is no accompanying autoimmune disease and "secondary" if the patient also has systemic lupus erythematosus (SLE) or an autoimmune disorder1,2,5. Certain infectious diseases and drugs may also result in the formation of antiphospholipid antibodies which do not appear to be associated with clinical complications and do not require therapy1,3,5.

Hematology 2005 © 2005 The American Society of Hematology. Summary: Even with the most complete datasets, it is still important for the physician to develop a therapeutic plan appropriate for the individual patient, based on clinical presentation, co-morbid conditions, and other variables. With uncommon disorders and limited datasets, such as with the antiphospholipid syndrome, decision-making becomes even more difficult. Table 3 presents a strategy that the author uses when evaluating and developing a treatment plan for a patient with antiphospholipid syndrome and thrombosis, based on the available studies summarized in this article. Critical areas for future research include identifying which patients with antiphospholipid antibodies are at highest risk for thrombotic complications, developing new antithrombotic agents that are effective and safe, and investigating novel approaches to eliminate the autoantibody and, hopefully, the increased prothrombotic state.

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Before the concept of an antiphospholipid syndrome originated, lupus patients with venous occlusions and particularly those with arterial occlusions were treated mainly with corticosteroids and immunosuppressives. In addition, patients with primary APS were often diagnosed as lupus and met classification criteria for this disease. This could have been considered reasonable were it not for the unnecessary steroid treatment they received instead of merely anticoagulant and/or platelet antiaggregant treatment. DONATO ALARCóN-SEGOVIA, MD, MS, PhD. J Rheumatol. VOLUME 30: NO. 9 SEPTEMBER 2003.

*Summary Points Antiphospholipid syndrome is characterized by the presence of venous and/or arterial thrombosis and/or pregnancy morbidity and the presence of antiphospholipid antibodies. Long-term anticoagulation is recommended for antiphospholipid syndrome patients with recurrent vascular events. For antiphospholipid syndrome patients with recurrent pregnancy events, aspirin plus heparin is recommended during pregnacy. Promotes an INR of >3.

Information provided by the UMHS Hemophilia and Coagulation Disorders Program, February 2003

Last Updated: August 10, 2007

Founded in 1988, the American Venous Forum provides a serious academic colloquium to physicians interested in the research, education, and clinical investigation in the field of venous diseases. The Forum membership includes more than 225 board-certified vascular surgeons who have an accomplished record of interest and contribution to the management of venous disease. The mission of the American Venous Forum is to improve the care of patients with venous and lymphatic disorders by providing a forum dedicated to education and to the exchange of information concerning basic and clinical research pertaining to the venous and lymphatic systems. In past years, the Forum has dedicated itself to academic pursuits through vigorous educational meetings throughout the country. Today, the Forum is a diverse organization that includes a directory of experienced investigators and clinicians, several of whom can also speak or assist in research on a variety of venous-related topics. The Forum also offers guidelines and protocols for the development of research and clinical trials. With the guidance of the AVF governing officers, the AVF will continue to bring medical professionals and patients the latest venous health information. The AVF By-Laws include more information on our objectives, committees, meetings, and dues.

Antiphospholipid syndrome (APS) is characterized by the following: venous or arterial thrombosis--a condition where clots, called thrombi, form in the blood vessels; recurrent miscarriages--the repeated loss of the fetus in pregnancies; and thrombocytopenia--a low number of blood platelets that can lead to bleeding, seen as bruising and tiny red dots on the skin.

Most patients with venous or arterial thrombosis and APS do well with conventional warfarin treatment (target INR 2.0 - 3.0). It is recommended that patients with recurrent thrombosis despite conventional doses of warfarin should maintain an INR of 3.0 - 4.0. This recommendation is based on one descriptive study and requires confirmation by randomised trials. The benefit of adding aspirin in arterial disease is not clear, and is likely to increase the risk of bleeding.

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