P1: SBT
0521779407-03a CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:18
Antiphospholipid Antibodies 137■Heparin-induced thrombocytopenia
■Thrombotic thrombocytopenic purpura (TTP)
■Disseminated intravascular coagulation (DIC)management
What to Do First
■Send lupus anticoagulant tests BEFORE starting heparin/warfarin.
■Treat thrombosis with heparin, thrombolytics, angioplasty, etc.
General Measures
■Rule out other causes of hypercoagulability.
■Eliminate contributing causes of hypercoagulability, such as exoge-
nous estrogen (oral contraceptives), smoking, etc.specific therapy
Indications
■Venous or arterial thrombosis secondary to APS is treated with long-
term high-intensity (INR 2 to 3) anti-coagulation.
■After ONE late or TWO or more early pregnancy losses, the next
pregnancy is treated with low-dose aspirin and heparin.
Treatment Options
■Prophylactic treatment can be considered in patients with LA or
moderate-to-high titer anticardiolipin or anti-beta2 glycoprotein I
who have not had thrombosis: low-dose aspirin in the general pop-
ulation, low-dose aspirin and hydroxychloroquine in SLE patients.
■Venous thrombosis: treatment of choice is long-term warfarin, with
an INR goal of 2 to 3.
➣Option 1: Regular-intensity warfarin
➣Option 2: 6 months warfarin; long-term warfarin for recurrent
VTE only, OR if antiphospholipid antibodies remain present
■Arterial thrombosis: treatment of choice is long-term high intensity
warfarin.
➣Option 1: Low-dose aspirin AND warfarin (INR 2 to 3)
➣Option 2: Aspirin only for stroke; long-term warfarin for recurrent
stroke only
■Pregnancy loss: regular heparin 5–10,000 units sc bid plus aspirin 81
mg
➣Option 1: Lovenox 20 mg sc bid plus aspirin 81 mg
➣Option 2: Aspirin 81 mg alone if there has been only ONE early
pregnancy loss