From the Guidelines
Testing for antiphospholipid syndrome is indicated in patients with a history of prior venous thromboembolism, second trimester abortion, or rheumatologic disorder, as well as those with stroke and persistent seropositivity for any of the antiphospholipid antibodies.
Diagnosis and Treatment
The diagnosis of antiphospholipid syndrome requires positive testing for lupus anticoagulant, anticardiolipin antibodies, or anti-β2-glycoprotein I antibodies on two occasions at least 12 weeks apart, along with clinical criteria of either vascular thrombosis or pregnancy morbidity 1. Some key points to consider in the diagnosis and treatment of antiphospholipid syndrome include:
- Clinical manifestations such as thrombosis or pregnancy complications
- Laboratory evidence of persistent antiphospholipid antibodies
- Treatment focuses on preventing thrombotic events through anticoagulation therapy
- For patients with a first venous thrombotic event, warfarin with a target INR of 2.0-3.0 is recommended indefinitely, as supported by the 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack 1
Key Considerations
Some other key considerations in the management of antiphospholipid syndrome include:
- For arterial thrombosis or recurrent venous events despite anticoagulation, higher intensity warfarin (INR 3.0-4.0) or warfarin plus antiplatelet therapy may be used
- For pregnant women with APS and recurrent pregnancy loss but no history of thrombosis, low-dose aspirin (81 mg daily) plus prophylactic heparin (either unfractionated heparin or low molecular weight heparin like enoxaparin 40 mg daily) is recommended
- Patients with catastrophic APS require aggressive treatment with anticoagulation, high-dose corticosteroids, plasma exchange, and/or intravenous immunoglobulin
- Regular monitoring of anticoagulation therapy is essential, and patients should be educated about bleeding risks and the importance of medication adherence 1
From the FDA Drug Label
For patients with a first episode of DVT or PE who have documented antiphospholipid antibodies or who have two or more thrombophilic conditions, treatment for 12 months is recommended and indefinite therapy is suggested
The indications to test for phospholipid syndrome (antiphospholipid syndrome) include:
- Documented deep venous thrombosis (DVT) or pulmonary embolism (PE) with no other identifiable cause
- Recurrent thrombotic events
- Thrombophilic conditions Testing for antiphospholipid antibodies is recommended in these cases to guide treatment decisions, including the use of warfarin for at least 12 months 2.
From the Research
Indications to Test Phospholipid Syndrome
The following are indications to test for phospholipid syndrome:
- Unprovoked venous or arterial thromboembolism in patients under 50 years of age 3
- Thrombosis at unusual sites 3
- Pregnancy complications, such as recurrent miscarriage 4, 3, 5
- Systemic lupus erythematosus (SLE) with thrombotic complications 4, 6
Diagnosis of Phospholipid Syndrome
Diagnosis is based on the presence of antiphospholipid antibodies, including:
- Lupus anticoagulant (LA) 6
- Anti-β2-glycoprotein I (anti-β2GPI) antibodies 4, 6
- Anticardiolipin (aCL) antibodies 4, 6, 5
- Anti-phosphatidylserine (aPS) antibodies 5
- Antibodies against phospholipid-binding plasma proteins, such as prothrombin (PT) and annexin V (Anx V) 4
Treatment of Phospholipid Syndrome
Treatment usually comprises antithrombotic therapy using: