Canterbury DHB

Context

Treatment Recommendations

In This Section

Thrombosis + Antiphospholipid Antibody Positive (ACL or LAC)

Pregnant + Antiphospholipid Antibody Positive (ACL or LAC)

Thrombosis + Antiphospholipid Antibody Positive (ACL or LAC)

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%.

Pregnant + Antiphospholipid Antibody Positive (ACL or LAC)

Primigravida

One or more Foetal Losses

Aspirin (75 mg/day)

Aspirin + Clexane
(1.5 mg/kg/day)

Note: Steroids have not been shown to be beneficial in this syndrome and may increase fetal mortality.

About this Canterbury DHB document (5204):

Document Owner:

Mark Smith (see Who's Who)

Issue Date:

August 2016

Next Review:

August 2018

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 5204