The Rheumatologist reports on a presentation by Lisa R. Sammaritano, MD, rheumatologist at HSS, at the 2019 American College of Rheumatology (ACR) State-of-the-Art Clinical Symposium, about treatment of antiphospholipid syndrome (APS), how to assess the risk of thrombosis, and secondary thrombosis prevention in APS.

Dr. Sammaritano explained patients are at high risk for thrombosis if they are positive for lupus anticoagulant antibodies, and especially at risk if they’re triple positive (which means being positive for lupus anticoagulant, anti-cardiolipin and anti-Beta2GPI antibodies).

“Our recommendation at this point is to [prescribe] low-dose aspirin [for] patients who have a high-risk profile - say they’re triple positive or [have] a very strong lupus anticoagulant [with or without the] presence of other thrombotic risk factors,” said Dr. Sammaritano. “In patients with lupus, the recommendation for low-dose aspirin is stronger,” she noted. Additionally, Dr. Sammaritano recommended lifelong warfarin for the secondary prevention of unprovoked venous thrombosis, based on a trial in which a high-intensity warfarin group was compared with a moderate-intensity group. However, Dr. Sammaritano cautioned the literature on this approach is not clear.

Furthermore, Dr. Sammaritano advised use of low-dose aspirin in combination with low-dose heparin, when there is more risk involved for an APS patient who is pregnant. “If your patients have a lot of risk factors, we can be flexible in using combination therapy,” she said. “If they’ve had one miscarriage, but they’re 40, had to go through IVF and are triple positive, I would add enoxaparin to that patient’s [treatment] rather than wait for them to have three early miscarriages,” she concluded.

Read the full article at the-rheumatologist.org.