Which Specialties Manage Antiphospholipid Syndrome
Rheumatologists are the primary specialists who should manage antiphospholipid syndrome (APS), with collaboration from hematology, obstetrics/gynecology, and other specialists depending on the clinical manifestations.
Primary Specialty Management
Rheumatology serves as the primary specialty for diagnosing and managing APS, particularly given its frequent association with systemic lupus erythematosus and other autoimmune conditions 1, 2.
APS requires expertise in autoimmune disease management, making rheumatologists ideally positioned to coordinate care and make treatment decisions regarding immunosuppression and anticoagulation 3, 4.
Collaborative Specialty Involvement
Hematology
Hematologists play a critical role in managing anticoagulation strategies, particularly for patients with thrombotic APS requiring long-term anticoagulation 1, 2.
They provide expertise in complex coagulation disorders and monitoring of anticoagulation therapy 5.
Obstetrics/Gynecology
Obstetricians are essential for managing pregnancy-related APS manifestations, including recurrent miscarriages, fetal death, and preeclampsia 6, 1.
For pregnant women with obstetric APS, combined management with prophylactic-dose heparin and low-dose aspirin is strongly recommended 6.
Obstetric specialists should collaborate with rheumatology throughout pregnancy and the 6-12 week postpartum period when anticoagulation continues 6.
Other Specialties Based on Clinical Manifestations
Neurology becomes involved when APS presents with stroke, transient ischemic attacks, or other neurological manifestations 1, 2.
Cardiology manages patients with cardiac valve disease, myocardial infarction, or other cardiovascular thrombotic events 1.
Nephrology addresses renal involvement, including thrombotic microangiopathy and renal artery thrombosis 2.
Dermatology evaluates cutaneous manifestations such as livedo reticularis and skin ulcerations 2.
Why Multidisciplinary Care Matters
APS symptoms can present across virtually any medical specialty because thrombosis can affect any vascular bed—venous, arterial, or microvascular 1, 2.
The wide spectrum of clinical manifestations requires coordinated care, but rheumatology should maintain primary oversight to ensure consistent immunologic management and monitoring of antiphospholipid antibodies 3, 4.
General practitioners and emergency physicians must maintain awareness of APS to facilitate appropriate referral, as delayed diagnosis increases morbidity from recurrent thrombotic events 1.
Common Pitfall to Avoid
- Do not assume APS management belongs solely to hematology simply because anticoagulation is the primary treatment—the underlying autoimmune pathophysiology requires rheumatologic expertise, particularly for catastrophic APS, microvascular manifestations, and non-thrombotic complications that do not respond to anticoagulation alone 5, 3, 4.