finding, primary antiphospholipid antibody syndrome. Although the antibodies prolong
the activated partial thromboplastin time (APTT) they predispose to thrombosis. Recurrent
miscarriages, as in this patient, may be a feature. Patients may present with idiopathic
recurrent DVT, arterial gangrene, livedo reticularis, cerebral infarcts, chorea and multi-
infarct dementia.
Doppler ultrasound of her leg veins will confirm the diagnosis of DVT. A thrombophilia
screen should be sent. Lupus serology should also be performed to define if the antiphos-
pholipid antibodies are part of SLE in this patient.
This patient should be immediately anticoagulated either with intravenous heparin or sub-
cutaneous low-molecular-weight heparin to prevent proximal propagation of the thrombus
and pulmonary emboli. The patient should be started on warfarin. Patients with antiphos-
pholipid antibodies require lifelong anticoagulation and consultation with a haematologist
to prevent further thrombotic events.
- Young patients with venous thromboses should be investigated for underlying causes.
- Patients with antiphospholipid antibodies require lifelong anticoagulation.
- Clinical diagnosis of a deep vein thrombosis is insensitive and has poor specificity.