Internal Medicine

P1: SBT

0521779407-03a CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:18

138 Antiphospholipid Antibodies Aortic Coarctation

■Catastrophic APS: multiple organ thrombosis requiring plasma-

pheresis or intravenous immunoglobulin in addition to heparin and

immunosuppression (corticosteroids)

Side Effects & Complications

■Bleeding risk increases with warfarin AND with addition of low-dose

aspirin.

Contraindications

■Profound thrombocytopenia (platelets <35,000) greatly increases

risk of bleeding; increase platelet count to safer levels with corti-

costeroids, intravenous immunoglobulin or other therapy, before

considering anticoagulation.

■Warfarin is not used during pregnancy; substitute heparin.

follow-up

■Monitor prothrombin time every 2 weeks to try to keep warfarin in

therapeutic window (INR goal is 2 to 3).

■Antibiotics may lead to marked changes in INR.

■Elective surgical procedures require switch to heparin before/after.

complications and prognosis

■75% of pregnancies treated with heparin and aspirin are successful;

40% of pregnancies treated with aspirin alone are successful.

■Recurrent thrombosis rate is less with long-term warfarin.

Aortic Coarctation....................................

KENDRICK A. SHUNK, MD, PhD

history & physical

History

■Risk factors

➣Male (2:1)

➣Gonadal dysgenesis

➣Other congenital cardiac disease (commonly bicuspid Aortic

valve)

Signs & Symptoms

■Headache, epistaxis, claudication or cold extremities with exercise

■Unequal upper extremity blood pressure (R>L)

■Right arm hypertension