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• #1 Patient education: Antiphospholipid syndrome (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/antiphospholipid-syndrome-beyond-the-basics/print

  ANTIPHOSPHOLIPID SYNDROME OVERVIEW […] Phospholipids are molecules that are present in the membranes that form the surface of cells, including blood cells and the cells that line blood vessels. In some people, the immune system develops abnormal antibodies (proteins) called „antiphospholipid antibodies” (aPL). These antibodies can affect blood flow and increase the risk of developing blood clots in the veins or arteries, as well as the risk of miscarriage or stillbirth among pregnant people. However, some people with aPL do not develop clots or other complications. […] People who have aPL and develop blood clots or pregnancy-related complications are said to have a syndrome called the antiphospholipid syndrome (APS). APS is an autoimmune disorder, meaning that it occurs when the body’s immune system mistakenly attacks healthy tissues and organs.

• #2 Patient education: Antiphospholipid syndrome (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/antiphospholipid-syndrome-beyond-the-basics

  ANTIPHOSPHOLIPID SYNDROME OVERVIEW […] Phospholipids are molecules that are present in the membranes that form the surface of cells, including blood cells and the cells that line blood vessels. In some people, the immune system develops abnormal antibodies (proteins) called „antiphospholipid antibodies” (aPL). These antibodies can affect blood flow and increase the risk of developing blood clots in the veins or arteries, as well as the risk of miscarriage or stillbirth among pregnant people. However, some people with aPL do not develop clots or other complications. […] People who have aPL and develop blood clots or pregnancy-related complications are said to have a syndrome called the antiphospholipid syndrome (APS). APS is an autoimmune disorder, meaning that it occurs when the body’s immune system mistakenly attacks healthy tissues and organs.

• #3 Patient education: Antiphospholipid syndrome (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/antiphospholipid-syndrome-beyond-the-basics/print

  APS is more common in people with other autoimmune or rheumatic diseases, particularly systemic lupus erythematosus (SLE). APS is referred to as „primary” when it occurs alone. […] ANTIPHOSPHOLIPID SYNDROME SYMPTOMS […] The symptoms of antiphospholipid syndrome (APS) are related primarily to abnormal blood clotting, miscarriage, or stillbirth. Rarely, patients with APS can also develop symptoms that are unrelated to clotting, such as low red blood cell counts (anemia), low platelet counts (thrombocytopenia), skin rashes and/or ulcers, memory problems, and/or heart valve disease. […] Thrombosis (blood clot) — The presence of antiphospholipid antibodies (aPL) can increase the risk of developing a thrombosis (blood clot) in a vein or artery, especially if the person also has other risk factors for blood clots. If they don’t get treatment for the first blood clot, people often experience repeated clots.

• #4 Antiphospholipid Syndrome

  https://rheumatology.org/patients/antiphospholipid-syndrome

  Antiphospholipid antibody syndrome (APS) is an autoimmune disease mostly affecting women between ages 30 and 40. […] APS increases the risk of blood clots, so treatment focuses on preventing clot-related complications. In acute events, initial management involves intravenous or subcutaneous (under the skin) injection of blood thinners, followed by long-term oral anticoagulants such as warfarin to reduce the risk of future clots. […] For pregnant women with APS, low molecular weight heparin with or without low-dose aspirin may be recommended to help prevent miscarriage. […] Individuals who take blood thinners long term must see their healthcare provider regularly to monitor the drug. Lifestyle changes should be implemented to prevent blood clots such as managing weight and stop smoking, avoiding estrogen therapy for birth control or menopausal symptoms unless a physician directs.

• #5 Patient education: Antiphospholipid syndrome (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/antiphospholipid-syndrome-beyond-the-basics/print

  Depending upon where the clot is located, it can affect blood flow and organ functioning. Many organs are susceptible to injury from blood clots. A clot that forms in or blocks an artery can impair blood flow to the brain, causing problems ranging from brief, reversible neurologic symptoms to a stroke that causes permanent brain damage. Impaired blood flow to the kidney can cause problems ranging from mild kidney dysfunction to kidney failure. […] Clots in large veins can lead to pain and swelling of the affected limb. This is referred to as a deep venous thrombosis (DVT). Legs are most often affected, but the arms can occasionally be involved. In addition to the pain and swelling that such blood clots cause, there is also a risk that a large clot will break free and travel through the heart to the blood vessels of the lungs, where it can block blood flow.

• #6 Patient education: Antiphospholipid syndrome (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/antiphospholipid-syndrome-beyond-the-basics/print

  A clot that travels is called an embolus; an embolus in the lung is called a pulmonary embolism. If a large vessel in the lung is blocked due to a pulmonary embolus, a person may feel chest pain, difficulty breathing, and sometimes coughs up of blood. Very large clots can lead to fainting or even death. […] Miscarriages — In pregnant people with APS, aPL can increase the risk of miscarriage (especially late in pregnancy and with placental vascular problems such as intrauterine growth restriction) or stillbirth. […] Thrombocytopenia — In some people, APS leads to a decrease in the number of blood cells called platelets. This condition is known as thrombocytopenia. […] Platelets are essential to the normal blood clotting process. When the number of platelets is significantly lowered (to less than 30,000), there is a risk of bleeding, particularly from the nose and gums, into the skin (called petechiae), from the digestive tract, and from the uterus in females. However, in people with APS, the reduced number of platelets may be associated with an increased risk of blood clots rather than bleeding problems.

• #7 Antiphospholipid Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430980/

  Collaborate with interprofessional healthcare teams to provide comprehensive care for patients with antiphospholipid syndrome. […] The clinical features vary significantly and can be as mild as asymptomatic APLA positivity or as severe as catastrophic APS. […] Arterial and venous thrombosis and pregnancy-related complications are the hallmarks of the disease. […] The role of anticoagulation has not been established in other non-criteria manifestations of APS. […] Early diagnosis of CAPS is crucial due to its high mortality rates. […] Combination therapy with glucocorticoids, heparin, and plasma exchange or IVIG is recommended over single agents as first-line treatment of patients with CAPS. […] Antiphospholipid antibody syndrome management requires an interprofessional team approach involving multiple specialties. […] The involvement of other specialties, such as neurology, nephrology, cardiology, and dermatology, may be necessary if the specific organ system is involved. […] Communication among the interprofessional team members and close patient monitoring is vital in managing APS.

• #8 Antiphospholipid Syndrome: Diagnosis & Treatment | HSS

  https://www.hss.edu/condition-list_antiphospholipid-syndrome.asp

  Antiphospholipid syndrome is a systemic autoimmune inflammatory disorder in which a persons immune system makes antibodies that can cause the formation of blood clots in the blood vessels as well as pregnancy problems. […] The primary symptoms of antiphospholipid syndrome are blood clots in the veins of the legs or arms, strokes (disruption of blood supply in part of the brain) and pregnancy problems such as miscarriage or pre-eclampsia. […] Antiphospholipid syndrome can occur in otherwise healthy individuals, or in patients with other autoimmune disorders. […] Women who have antiphospholipid syndrome are more likely to develop pregnancy complications, including miscarriages, preterm delivery (before 37 weeks), preeclampsia and eclampsia intrauterine growth restriction (reduced fetus size), and blood clots occurring while they are pregnant.

• #9 Antiphospholipid antibody syndrome – NYSORA

  https://www.nysora.com/anesthesia/antiphospholipid-antibody-syndrome/

  Antiphospholipid syndrome (APS) or Hughes syndrome is a disorder of the immune system that creates antibodies that attack tissues in the body by mistake. […] These antibodies can cause blood clots to form in arteries and veins, leading to a heart attack, stroke, and other conditions. […] Can result in miscarriage and stillbirth during pregnancy. […] Antiphospholipid syndrome is more common in women than in men. […] In very rare cases, blood clots can suddenly form throughout the body, resulting in multiple organ failures → catastrophic antiphospholipid syndrome (CAPS), or Asherson syndrome. […] CAPS requires immediate emergency treatment with high-dose anticoagulants. […] Primary thromboprophylaxis for aPL carriers with no prior history of vascular thrombosis and/or obstetric events includes low-dose aspirin (75-100 mg/d) and lifestyle changes.

• #10

  https://www.nhs.uk/conditions/antiphospholipid-syndrome/treatment/

  Treatment for antiphospholipid syndrome (APS) aims to reduce your risk of developing more blood clots. […] Most people with APS need to take anticoagulant or antiplatelet medication daily for the rest of their life. […] Women diagnosed with APS are strongly advised to plan for any future pregnancy. […] Treatment during pregnancy involves taking daily doses of aspirin or heparin, or a combination of both. […] If you’re diagnosed with APS, it’s important to take all possible steps to reduce your risk of developing blood clots.

• #11

  https://www.nhs.uk/conditions/antiphospholipid-syndrome/

  Antiphospholipid syndrome (APS), sometimes known as Hughes syndrome, is a disorder of the immune system that causes an increased risk of blood clots. […] Although there’s no cure for APS, the risk of developing blood clots can be greatly reduced if it’s correctly diagnosed. […] An anticoagulant medicine, such as warfarin, or an antiplatelet, such as low-dose aspirin, is usually prescribed. […] Treatment with these medications can also improve a pregnant woman’s chance of having a successful pregnancy. […] With treatment, it’s estimated there’s about an 80% chance of having a successful pregnancy. […] Most people respond well to treatment and can lead normal, healthy lives. […] But a small number of people with APS continue to experience blood clots despite extensive treatment.

• #12 Patient education: Antiphospholipid syndrome (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/antiphospholipid-syndrome-beyond-the-basics/print

  ANTIPHOSPHOLIPID SYNDROME DIAGNOSIS […] A diagnosis of antiphospholipid syndrome (APS) is based upon a person’s medical history (ie, whether they have had symptoms or problems consistent with APS) and laboratory test results (these include blood tests to check for antiphospholipid antibodies [aPL]). It is important to note that not every “positive” aPL test is clinically relevant; aPL test results should be interpreted by an experienced clinician. […] TREATMENT AND PREVENTION OF BLOOD CLOTS […] Anticoagulants — Anticoagulants are medications that prevent an existing blood clot from enlarging and that prevent the formation of additional blood clots. Anticoagulants are commonly referred to as blood thinners, but they do not actually thin the blood. […] People with antiphospholipid syndrome (APS) and acute blood clots are often treated with an injectable anticoagulant called heparin or low molecular weight heparin (LMWH). In some cases, the heparin is given into a vein while the person is in the hospital. In other cases, heparin is injected under the skin.

• #13 Patient education: Antiphospholipid syndrome (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/antiphospholipid-syndrome-beyond-the-basics/print

  There are several types of LMWH, including enoxaparin (brand name: Lovenox), dalteparin (brand name: Fragmin), or tinzaparin (brand name: Innohep). These can be injected beneath the skin by the person, a family member, or a home health nurse. This is usually continued for several days, along with another medication called warfarin (brand name: Jantoven). Warfarin is an anticoagulant medication that is taken by mouth, as a pill, for the long-term treatment of blood clots and the prevention of recurrence. Heparin can be stopped once warfarin levels are stable. […] Monitoring of warfarin — Careful monitoring and periodic adjustments in the warfarin dose are typically needed to maintain a level that prevents clots but that does not cause significant bleeding. The blood test used to measure the effects of warfarin is called the prothrombin time (called pro time, or PT). The PT is a laboratory test that measures the time it takes for the clotting mechanism to progress. It is particularly sensitive to the clotting factors affected by warfarin. The PT is used to compute a value known as the International Normalized Ratio (INR). The INR is a way of expressing the PT in a standardized way; this ensures that results obtained by different laboratories can be reliably compared.

• #14 Patient education: Antiphospholipid syndrome (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/antiphospholipid-syndrome-beyond-the-basics/print

  The longer it takes the blood to clot, the higher the PT and INR. The target INR range depends upon the clinical situation. In most cases, the target range is 2 to 3. If the INR is below the target range (ie, under-anticoagulated), there is a risk of clotting. If, on the other hand, the INR is above the target range (ie, over-anticoagulated), there is an increased risk of bleeding. […] Antiplatelet treatments — Aspirin is another medication sometimes recommended for people with APS. Aspirin inhibits the clumping of platelets; platelets are tiny cell fragments in the blood that have a role in blood clotting. Under normal circumstances, platelets clump together and help form blood clots to stop bleeding when needed. […] Aspirin is sometimes used in addition to warfarin. It is not usually used as a replacement for warfarin, especially in people with a history of serious and recurrent blood clots.

• #15 Antiphospholipid Syndrome and Its Management

  https://www.uspharmacist.com/article/antiphospholipid-syndrome-and-its-management

  Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by thrombosis or pregnancy morbidity coupled with persistent antiphospholipid antibodies. […] Management involves identifying and mitigating thrombosis risk factors. Vitamin K antagonists are the standard of care; the use of aspirin is controversial and depends on the patients risk profile. […] It is important to identify and address factors that increase thrombosis risk, such as high-risk aPL profile, coexistence of other systemic autoimmune diseases, and traditional risk factors for cardiovascular disease (e.g., smoking, hypertension, diabetes, hyperlipidemia). […] Vitamin K antagonists (VKAs) continue to be the standard of care for long-term anticoagulation in most APS patients despite the introduction of direct oral anticoagulants (DOACs) to the market.

• #16 Patient education: Antiphospholipid syndrome (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/antiphospholipid-syndrome-beyond-the-basics/print

  There are several types of LMWH, including enoxaparin (brand name: Lovenox), dalteparin (brand name: Fragmin), or tinzaparin (brand name: Innohep). These can be injected beneath the skin by the person, a family member, or a home health nurse. This is usually continued for several days, along with another medication called warfarin (brand name: Jantoven). Warfarin is an anticoagulant medication that is taken by mouth, as a pill, for the long-term treatment of blood clots and the prevention of recurrence. Heparin can be stopped once warfarin levels are stable. […] Monitoring of warfarin — Careful monitoring and periodic adjustments in the warfarin dose are typically needed to maintain a level that prevents clots but that does not cause significant bleeding. The blood test used to measure the effects of warfarin is called the prothrombin time (called pro time, or PT). The PT is a laboratory test that measures the time it takes for the clotting mechanism to progress. It is particularly sensitive to the clotting factors affected by warfarin. The PT is used to compute a value known as the International Normalized Ratio (INR). The INR is a way of expressing the PT in a standardized way; this ensures that results obtained by different laboratories can be reliably compared.

• #17 Antiphospholipid Syndrome Follow-up: Further Outpatient Care, Transfer, Deterrence/Prevention

  https://emedicine.medscape.com/article/333221-followup

  Carefully monitor medication doses and the international normalized ratio (INR) if applicable. […] Closely observe the patient for clinical events. […] Ensure the care of any underlying connective-tissue disease. […] For treatment of seriously ill patients with catastrophic antiphospholipid syndrome (CAPS), transfer the patient to a setting where plasma exchange can be performed or where intravenous immunoglobulin or cyclophosphamide can be administered if needed. […] Instruct the patient to avoid smoking. […] Inform the patient to avoid oral contraceptives or estrogen replacement therapy. […] Ensure that the patient avoids any prolonged immobilization. […] With appropriate medication and lifestyle modifications, most individuals with primary antiphospholipid syndrome (APS) lead normal healthy lives.

• #18 EULAR recommendations for the management of antiphospholipid syndrome in adults | Annals of the Rheumatic Diseases

  https://ard.bmj.com/content/78/10/1296

  In patients with APS with first arterial thrombosis, treatment with VKA with INR 2-3 or INR 3-4 is recommended, considering the individuals bleeding/thrombosis risk. […] Rivaroxaban should not be used in patients with APS with triple aPL positivity. […] For patients with recurrent arterial or venous thrombosis despite adequate treatment, addition of LDA, increase of INR target to 3-4 or switch to low molecular weight heparin may be considered. […] In women with prior obstetric APS, combination treatment with LDA and prophylactic dosage heparin during pregnancy is recommended. […] In patients with recurrent pregnancy complications, increase of heparin to therapeutic dose, addition of hydroxychloroquine or addition of low-dose prednisolone in the first trimester may be considered. […] These recommendations aim to guide treatment in adults with APS. High-quality evidence is limited, indicating a need for more research.

• #19

  https://www.nhs.uk/conditions/antiphospholipid-syndrome/treatment/

  Treatment for antiphospholipid syndrome (APS) aims to reduce your risk of developing more blood clots. […] Most people with APS need to take anticoagulant or antiplatelet medication daily for the rest of their life. […] Women diagnosed with APS are strongly advised to plan for any future pregnancy. […] Treatment during pregnancy involves taking daily doses of aspirin or heparin, or a combination of both. […] If you’re diagnosed with APS, it’s important to take all possible steps to reduce your risk of developing blood clots.

• #20 Patient education: Antiphospholipid syndrome (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/antiphospholipid-syndrome-beyond-the-basics/print

  ANTIPHOSPHOLIPID SYNDROME AND PREGNANCY […] Pregnant people with antiphospholipid syndrome (APS) have an increased risk of developing a thrombosis (blood clot in a vein or artery) and of having a miscarriage compared with pregnant people without APS. They may also be at risk for other pregnancy-related complications, including preeclampsia and decreased blood flow to the fetus resulting in intrauterine growth restriction. […] Several treatments are available to reduce these risks. Treatment depends upon the person’s history of blood clots, miscarriage, stillbirth, and preeclampsia, as well as current antibody levels. For people who have antiphospholipid antibodies (aPL) but no history of blood clots or miscarriage, treatment may or may not be recommended. […] The following is a general description of available treatments.

• #21 Patient education: Antiphospholipid syndrome (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/antiphospholipid-syndrome-beyond-the-basics/print

  Aspirin — Low-dose aspirin may be used for pregnant people with APS in combination with heparin injections. Low-dose aspirin can be started before a person starts trying to get pregnant. […] Heparin — Heparin must be given as an injection, either under the skin or into a vein. Most pregnant people who use heparin are taught to give their own injections into the skin. […] There are two types of heparin: unfractionated and low molecular weight heparin (LMWH). […] Unfractionated heparin must be injected twice per day and has a risk of causing excessive bleeding, a low platelet count, and osteoporosis. […] LMWH is usually injected once per day and has a lower risk of excessive bleeding, low platelet count, and bone thinning (osteoporosis) compared with unfractionated heparin.

• #22 Patient education: Antiphospholipid syndrome (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/antiphospholipid-syndrome-beyond-the-basics/print

  Heparin is usually started once pregnancy is confirmed and is usually stopped temporarily for planned procedures (eg, amniocentesis, cesarean section) and when labor begins. Either heparin or warfarin is recommended for six to eight weeks after delivery. […] Warfarin — Warfarin is not recommended for pregnant people with APS because of the potential risks to the developing fetus. Warfarin must be stopped before six weeks of pregnancy. […] Warfarin can be restarted after delivery and is often the preferred treatment for people with APS during the postpartum stage (the six to eight weeks following delivery). Warfarin is safe to take while breastfeeding. […] Preventing pregnancy — People with aPL (with or without APS) should not use birth control methods that contain estrogen because estrogen can increase the risk of developing a blood clot. A number of other methods of birth control are available, including progestin-only pills, an intrauterine device (IUD), condoms, a diaphragm, an injection (eg, Depo Provera), or a surgical procedure. These options are discussed separately.

• #23 Antiphospholipid Syndrome Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/333221-treatment

  Patients with antiphospholipid syndrome (APS) may be evaluated in an outpatient setting. Inpatient evaluation is required if the patient presents with a significant clinical event. Patients with catastrophic APS (CAPS) require intense observation and treatment, often in an intensive care unit. […] In general, treatment regimens for APS must be individualized according to the patient’s current clinical status and history of thrombotic events. Asymptomatic individuals in whom blood test findings are positive do not require specific treatment. […] Prophylactic anticoagulation is needed during surgery or hospitalization. Management of any associated autoimmune disease is necessary. […] Treatment for significant thrombotic events in patients with APS is generally lifelong. […] Guidelines from the American College of Obstetricians and Gynecologists include the following recommendations: Women with APS who have a history of thrombosis in previous pregnancies should receive prophylactic anticoagulation during pregnancy and for 6 weeks postpartum.

• #24 Antiphospholipid Syndrome Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/333221-treatment

  Patients with antiphospholipid syndrome (APS) may be evaluated in an outpatient setting. Inpatient evaluation is required if the patient presents with a significant clinical event. Patients with catastrophic APS (CAPS) require intense observation and treatment, often in an intensive care unit. […] In general, treatment regimens for APS must be individualized according to the patient’s current clinical status and history of thrombotic events. Asymptomatic individuals in whom blood test findings are positive do not require specific treatment. […] Prophylactic anticoagulation is needed during surgery or hospitalization. Management of any associated autoimmune disease is necessary. […] Treatment for significant thrombotic events in patients with APS is generally lifelong. […] Guidelines from the American College of Obstetricians and Gynecologists include the following recommendations: Women with APS who have a history of thrombosis in previous pregnancies should receive prophylactic anticoagulation during pregnancy and for 6 weeks postpartum.

• #25 Antiphospholipid Syndrome Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/333221-treatment

  For women with a history of APS and prior thrombosis, anticoagulation with therapeutic-dose low molecular weight heparin (LMWH) and low-dose aspirin is recommended. […] For women with a history of APS without thrombosis but with prior pregnancy loss, prophylactic-dose LMWH and low-dose aspirin are recommended. […] Corticosteroids have not been proven effective for persons with primary APS, and they have been shown to increase maternal morbidity and fetal prematurity rates. […] Unfortunately, current treatment fails to prevent complications in 20-30% of APS pregnancies. […] In patients with a history of SLE and APS, hydroxychloroquine should be used during pregnancy. […] Placement of an inferior vena cava (IVC) filter may be considered in patients with APS who require cessation of anticoagulation or who continue to experience thrombotic complications despite maximal anticoagulation.

• #26

  https://www.nhs.uk/conditions/antiphospholipid-syndrome/

  Antiphospholipid syndrome (APS), sometimes known as Hughes syndrome, is a disorder of the immune system that causes an increased risk of blood clots. […] Although there’s no cure for APS, the risk of developing blood clots can be greatly reduced if it’s correctly diagnosed. […] An anticoagulant medicine, such as warfarin, or an antiplatelet, such as low-dose aspirin, is usually prescribed. […] Treatment with these medications can also improve a pregnant woman’s chance of having a successful pregnancy. […] With treatment, it’s estimated there’s about an 80% chance of having a successful pregnancy. […] Most people respond well to treatment and can lead normal, healthy lives. […] But a small number of people with APS continue to experience blood clots despite extensive treatment.

• #27 Antiphospholipid Syndrome Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/333221-treatment

  For women with a history of APS and prior thrombosis, anticoagulation with therapeutic-dose low molecular weight heparin (LMWH) and low-dose aspirin is recommended. […] For women with a history of APS without thrombosis but with prior pregnancy loss, prophylactic-dose LMWH and low-dose aspirin are recommended. […] Corticosteroids have not been proven effective for persons with primary APS, and they have been shown to increase maternal morbidity and fetal prematurity rates. […] Unfortunately, current treatment fails to prevent complications in 20-30% of APS pregnancies. […] In patients with a history of SLE and APS, hydroxychloroquine should be used during pregnancy. […] Placement of an inferior vena cava (IVC) filter may be considered in patients with APS who require cessation of anticoagulation or who continue to experience thrombotic complications despite maximal anticoagulation.

• #28 Patient education: Antiphospholipid syndrome (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/antiphospholipid-syndrome-beyond-the-basics/print

  Treatment before and during surgery — Anticoagulant and antiplatelet treatments may need to be adjusted before, during, and after surgery or other procedures that have a risk of bleeding. The goal of treatment adjustments is to minimize the risk of new blood clots as well as the risk of excessive bleeding. This usually involves stopping warfarin several days before surgery. […] The person may be given heparin before and after surgery, depending upon several factors (the person’s previous history of blood clots, type of surgery, etc). Warfarin can usually be restarted within 12 hours after surgery. A person should speak with the provider who prescribes their warfarin to determine the best treatment regimen (and the timing) before and after surgery. […] TREATMENT OF LOW PLATELETS […] People with mild thrombocytopenia (low platelet count) due to antiphospholipid syndrome (APS) usually do not require treatment. In more severe cases, medications (including steroids or immune globulins) are used to help increase the platelet count.

• #29 Antiphospholipid Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430980/

  Collaborate with interprofessional healthcare teams to provide comprehensive care for patients with antiphospholipid syndrome. […] The clinical features vary significantly and can be as mild as asymptomatic APLA positivity or as severe as catastrophic APS. […] Arterial and venous thrombosis and pregnancy-related complications are the hallmarks of the disease. […] The role of anticoagulation has not been established in other non-criteria manifestations of APS. […] Early diagnosis of CAPS is crucial due to its high mortality rates. […] Combination therapy with glucocorticoids, heparin, and plasma exchange or IVIG is recommended over single agents as first-line treatment of patients with CAPS. […] Antiphospholipid antibody syndrome management requires an interprofessional team approach involving multiple specialties. […] The involvement of other specialties, such as neurology, nephrology, cardiology, and dermatology, may be necessary if the specific organ system is involved. […] Communication among the interprofessional team members and close patient monitoring is vital in managing APS.

• #30 Antiphospholipid Syndrome: Diagnosis and Management

  https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2018/05/24/13/09/diagnosis-and-management-of-the-antiphospholipid-syndrome

  Antiphospholipid syndrome (APS) is a systemic autoimmune disease defined by thrombotic or obstetrical events that occur in patients with persistent antiphospholipid antibodies. […] The use of low-dose aspirin for primary thrombosis prevention in patients with APS but no prior thrombosis is controversial. No other prophylactic therapy has been robustly proven effective. […] For patients with APS and a history of venous thrombosis, treatment with heparin and warfarin (target international normalized ratio [INR] 2-3) is recommended. Anticoagulation is usually recommended indefinitely for patients whose venous thrombosis was unprovoked. […] Early treatment is essential in catastrophic APS. This usually involves anticoagulants, steroids, intravenous immune globulin, and plasma exchange. […] Low-dose aspirin and therapeutic-dose heparin should be used in pregnant women with thrombotic APS, regardless of the pregnancy history. Low-dose aspirin or prophylactic-dose heparin can be used in pregnant women with APS, but no prior history of thrombosis (including 6 weeks postpartum).

• #31

  https://www.nhs.uk/conditions/antiphospholipid-syndrome/treatment/

  Treatment for antiphospholipid syndrome (APS) aims to reduce your risk of developing more blood clots. […] Most people with APS need to take anticoagulant or antiplatelet medication daily for the rest of their life. […] Women diagnosed with APS are strongly advised to plan for any future pregnancy. […] Treatment during pregnancy involves taking daily doses of aspirin or heparin, or a combination of both. […] If you’re diagnosed with APS, it’s important to take all possible steps to reduce your risk of developing blood clots.

• #32

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=ut3224

  Antiphospholipid syndrome (APS) is a condition that makes the blood clot too easily. This can lead to serious problems, such as a stroke, a heart attack, and blood clots in the legs or lungs. During pregnancy, APS can lead to miscarriage and other serious pregnancy problems. […] APS is most often treated with blood thinners. If you’re pregnant, you will need treatment. Your health will be closely watched. […] Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take. […] If you are pregnant, get any special care that your doctor recommends. This may include medicine that may help prevent a miscarriage. […] Watch closely for changes in your health, and be sure to contact your doctor or nurse advice line if you do not get better as expected.

• #33 Antiphospholipid Syndrome Follow-up: Further Outpatient Care, Transfer, Deterrence/Prevention

  https://emedicine.medscape.com/article/333221-followup

  Carefully monitor medication doses and the international normalized ratio (INR) if applicable. […] Closely observe the patient for clinical events. […] Ensure the care of any underlying connective-tissue disease. […] For treatment of seriously ill patients with catastrophic antiphospholipid syndrome (CAPS), transfer the patient to a setting where plasma exchange can be performed or where intravenous immunoglobulin or cyclophosphamide can be administered if needed. […] Instruct the patient to avoid smoking. […] Inform the patient to avoid oral contraceptives or estrogen replacement therapy. […] Ensure that the patient avoids any prolonged immobilization. […] With appropriate medication and lifestyle modifications, most individuals with primary antiphospholipid syndrome (APS) lead normal healthy lives.

• #34 Antiphospholipid Syndrome Follow-up: Further Outpatient Care, Transfer, Deterrence/Prevention

  https://emedicine.medscape.com/article/333221-followup

  However, subsets of patients continue to have thrombotic events despite aggressive therapies. […] In these patients and in patients with catastrophic APS, the disease course can be devastating, often leading to significant morbidity or early death. […] Patient education may include the following: Stress the importance of early recognition of a possible clinical event. […] Instruct patients taking warfarin to avoid sports with excessive contact. […] Instruct patients taking warfarin to avoid excessive consumption of foods that contain vitamin K. […] Limit activity in patients with acute deep venous thrombosis (DVT). […] Instruct the patient to avoid prolonged immobilization. […] Discuss the importance of planned pregnancies so that long-term warfarin can be switched to aspirin and heparin before pregnancy is attempted. […] Stress the importance of minimizing modifiable risk factors in primary prevention of aPL-positive patients with no history of thrombosis.

• #35 Antiphospholipid Syndrome: Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/21685-antiphospholipid-syndrome

  Antiphospholipid syndrome (APS) is an autoimmune disease that can cause blood clots and pregnancy complications. Most people with APS need to take blood thinners to prevent future blood clots and miscarriages. […] Your provider will suggest treatments that lower your risk of having a blood clot. The most common treatments include anticoagulant medications (blood thinners), including: […] Your provider might recommend medications to prevent miscarriages if you’re pregnant and have APS, including: […] These treatments are safe if you’re pregnant and shouldn’t harm you or the fetus. […] The most important part of living with APS is preventing blood clots. Taking blood-thinning medication is a big part of that prevention. […] Antiphospholipid syndrome can increase the risk of pregnancy-related complications. Talk to your healthcare provider if you’re concerned about any risks or pregnancy complications you might experience. […] Most people managing APS with blood thinners can safely get pregnant and have biological children.

• #36 Patient education: Antiphospholipid syndrome (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/antiphospholipid-syndrome-beyond-the-basics/print

  Treatment before and during surgery — Anticoagulant and antiplatelet treatments may need to be adjusted before, during, and after surgery or other procedures that have a risk of bleeding. The goal of treatment adjustments is to minimize the risk of new blood clots as well as the risk of excessive bleeding. This usually involves stopping warfarin several days before surgery. […] The person may be given heparin before and after surgery, depending upon several factors (the person’s previous history of blood clots, type of surgery, etc). Warfarin can usually be restarted within 12 hours after surgery. A person should speak with the provider who prescribes their warfarin to determine the best treatment regimen (and the timing) before and after surgery. […] TREATMENT OF LOW PLATELETS […] People with mild thrombocytopenia (low platelet count) due to antiphospholipid syndrome (APS) usually do not require treatment. In more severe cases, medications (including steroids or immune globulins) are used to help increase the platelet count.

• #37 Patient education: Antiphospholipid syndrome (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/antiphospholipid-syndrome-beyond-the-basics

  The person may be given heparin before and after surgery, depending upon several factors (the person’s previous history of blood clots, type of surgery, etc). Warfarin can usually be restarted within 12 hours after surgery. A person should speak with the provider who prescribes their warfarin to determine the best treatment regimen (and the timing) before and after surgery. […] TREATMENT OF LOW PLATELETS […] People with mild thrombocytopenia (low platelet count) due to antiphospholipid syndrome (APS) usually do not require treatment. In more severe cases, medications (including steroids or immune globulins) are used to help increase the platelet count. […] ANTIPHOSPHOLIPID SYNDROME AND PREGNANCY […] Pregnant people with antiphospholipid syndrome (APS) have an increased risk of developing a thrombosis (blood clot in a vein or artery) and of having a miscarriage compared with pregnant people without APS. They may also be at risk for other pregnancy-related complications, including preeclampsia and decreased blood flow to the fetus resulting in intrauterine growth restriction.

• #38 Patient education: Antiphospholipid syndrome (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/antiphospholipid-syndrome-beyond-the-basics/print

  Heparin is usually started once pregnancy is confirmed and is usually stopped temporarily for planned procedures (eg, amniocentesis, cesarean section) and when labor begins. Either heparin or warfarin is recommended for six to eight weeks after delivery. […] Warfarin — Warfarin is not recommended for pregnant people with APS because of the potential risks to the developing fetus. Warfarin must be stopped before six weeks of pregnancy. […] Warfarin can be restarted after delivery and is often the preferred treatment for people with APS during the postpartum stage (the six to eight weeks following delivery). Warfarin is safe to take while breastfeeding. […] Preventing pregnancy — People with aPL (with or without APS) should not use birth control methods that contain estrogen because estrogen can increase the risk of developing a blood clot. A number of other methods of birth control are available, including progestin-only pills, an intrauterine device (IUD), condoms, a diaphragm, an injection (eg, Depo Provera), or a surgical procedure. These options are discussed separately.

• #39 Antiphospholipid Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430980/

  Collaborate with interprofessional healthcare teams to provide comprehensive care for patients with antiphospholipid syndrome. […] The clinical features vary significantly and can be as mild as asymptomatic APLA positivity or as severe as catastrophic APS. […] Arterial and venous thrombosis and pregnancy-related complications are the hallmarks of the disease. […] The role of anticoagulation has not been established in other non-criteria manifestations of APS. […] Early diagnosis of CAPS is crucial due to its high mortality rates. […] Combination therapy with glucocorticoids, heparin, and plasma exchange or IVIG is recommended over single agents as first-line treatment of patients with CAPS. […] Antiphospholipid antibody syndrome management requires an interprofessional team approach involving multiple specialties. […] The involvement of other specialties, such as neurology, nephrology, cardiology, and dermatology, may be necessary if the specific organ system is involved. […] Communication among the interprofessional team members and close patient monitoring is vital in managing APS.

• #40 Antiphospholipid Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430980/

  Collaborate with interprofessional healthcare teams to provide comprehensive care for patients with antiphospholipid syndrome. […] The clinical features vary significantly and can be as mild as asymptomatic APLA positivity or as severe as catastrophic APS. […] Arterial and venous thrombosis and pregnancy-related complications are the hallmarks of the disease. […] The role of anticoagulation has not been established in other non-criteria manifestations of APS. […] Early diagnosis of CAPS is crucial due to its high mortality rates. […] Combination therapy with glucocorticoids, heparin, and plasma exchange or IVIG is recommended over single agents as first-line treatment of patients with CAPS. […] Antiphospholipid antibody syndrome management requires an interprofessional team approach involving multiple specialties. […] The involvement of other specialties, such as neurology, nephrology, cardiology, and dermatology, may be necessary if the specific organ system is involved. […] Communication among the interprofessional team members and close patient monitoring is vital in managing APS.

• #41 Antiphospholipid syndrome – APS: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000547.htm

  If you have APS and become pregnant, you will need to be followed closely by a provider who is an expert in this condition. You will not take warfarin during pregnancy, but will be given heparin shots instead. […] Without treatment, people with APS will have repeat clotting events. Most of the time, outcome is good with proper treatment, which includes long-term anticoagulation therapy. Some people may have blood clots that are hard to control in spite of treatments. This can lead to CAPS, which can be life-threatening. […] Contact your provider if you notice symptoms of a blood clot, such as: Swelling or redness in the leg, Shortness of breath, Pain, numbness, and pale skin color in an arm or leg.

• #42

  https://www.nhs.uk/conditions/antiphospholipid-syndrome/

  Antiphospholipid syndrome (APS), sometimes known as Hughes syndrome, is a disorder of the immune system that causes an increased risk of blood clots. […] Although there’s no cure for APS, the risk of developing blood clots can be greatly reduced if it’s correctly diagnosed. […] An anticoagulant medicine, such as warfarin, or an antiplatelet, such as low-dose aspirin, is usually prescribed. […] Treatment with these medications can also improve a pregnant woman’s chance of having a successful pregnancy. […] With treatment, it’s estimated there’s about an 80% chance of having a successful pregnancy. […] Most people respond well to treatment and can lead normal, healthy lives. […] But a small number of people with APS continue to experience blood clots despite extensive treatment.

• #43 Antiphospholipid Syndrome: Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/21685-antiphospholipid-syndrome

  Antiphospholipid syndrome (APS) is an autoimmune disease that can cause blood clots and pregnancy complications. Most people with APS need to take blood thinners to prevent future blood clots and miscarriages. […] Your provider will suggest treatments that lower your risk of having a blood clot. The most common treatments include anticoagulant medications (blood thinners), including: […] Your provider might recommend medications to prevent miscarriages if you’re pregnant and have APS, including: […] These treatments are safe if you’re pregnant and shouldn’t harm you or the fetus. […] The most important part of living with APS is preventing blood clots. Taking blood-thinning medication is a big part of that prevention. […] Antiphospholipid syndrome can increase the risk of pregnancy-related complications. Talk to your healthcare provider if you’re concerned about any risks or pregnancy complications you might experience. […] Most people managing APS with blood thinners can safely get pregnant and have biological children.

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