When do I order laboratory testing for antiphospholipid antibodies?Patients presenting with a new, spontaneous venous thromboembolic event. Younger patients presenting with a new, arterial thromboembolic event. Patients with atypical thromboembolic events and unusual presentations.
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How do I treat patients with antiphospholipid syndrome and venous thromboembolic events?Confirm that baseline prothrombin time is normal (if not, evaluate further with mixing studies, factor II level). For initial thromboembolic event, treat with oral anticoagulation with a target INR of 2.5 (range, 2.0 to 3.0) for a minimum of 12 months. Treat any additional prothrombotic states, such as elevated homocysteine levels with folic acid. For recurrent thromboembolic events, use either a higher target INR (3.5, range 3.0 to 4.0), an alternative anticoagulant (e.g., low molecular weight heparin), or consider an immunomodulatory strategy, particularly if secondary antiphospholipid syndrome.
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How do I treat patients with antiphospholipid syndrome and arterial thromboembolic events?Confirm that baseline prothrombin time is normal. For initial thromboembolic event, treat with oral anticoagulation with a target INR of 3.0 (2.5 to 3.5) for a minimum of 12 months. Treat any additional prothrombotic states, such as hypercholesterolemia and hypertension. For recurrent thromboembolic events, use either a higher target INR (above 3.0), an antiplatelet agent in addition to the anticoagulant, an alternative anticoagulant, or consider an immunomodulatory strategy.
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