Canterbury DHB
Commence treatment with heparin then warfarin in the standard fashion.
As these patients have a high risk of recurrence, long term anticoagulation is recommended, even for the initial clot. Rarely, the antiphospholipid antibodies may disappear spontaneously so retesting is recommended every year or two. The intensity of anticoagulation recommendation is from 2-3 (or 3-4 for arterial thrombosis).
Try to individualise care, taking into account perceived risks of both rethrombosis and bleeding. If the lupus anticoagulant prolongs the baseline INR, then warfarin monitoring is difficult. Consider using (if possible) a thromboplastin that is insensitive to the LAC or monitoring by FX or FII assays. An INR of 2.0-3.5 correlates with a FX level of 11-42% or a FII level of 5-35%.
Primigravida |
One or more Foetal Losses |
Aspirin (75 mg/day) |
Aspirin + Clexane |
Note: Steroids have not been shown to be beneficial in this syndrome and may increase fetal mortality.
Topic Code: 5204