Patient Is Clotting: What Do You Mean, the aPTT Is Prolonged?

Dennis Williams, MD; Duncan C. MacIvor, MD

Disclosures

February 21, 2013

In This Article

Treatment Considerations for APS

Treatment for patients with aPL-Abs accompanying acute venous or arterial thrombosis is similar to that for patients without these antibodies: anticoagulation therapy with warfarin.[4] The duration of therapy is not standard, but observational studies suggest high rates of recurrence if therapy is discontinued.[19] The management of pregnant patients with APS includes aspirin and heparin therapy. Prophylaxis with aspirin in asymptomatic patients with aPL-Abs is controversial, especially in asymptomatic patients with aPL-Abs with or without underlying disease.[20] Additional medications that continue to be investigated include statins, hydroxychloroquine, and direct thrombin inhibitors. Evidence suggests that hydroxychloroquine reduces the thrombotic risk in aPL-Ab positive patients with lupus.[20] Dabigatran, an oral direct thrombin inhibitor, is also currently being considered. Although its ease of dosing and predictable anticoagulant response are attractive, no means of timely reversal of the agent in instances of life-threatening bleeding is currently available.

Because CAPS is a rare condition, its treatment is not standardized. It is important to treat any underlying precipitating cause, such as infection. Anticoagulation therapy is the normal approach and high-dose corticosteroids may be considered. If the patient does not respond appropriately, intravenous immunoglobulin and/or plasma exchange may be considered.[1,4] Additional agents, including rituximab or cyclophosphamide, may be used when all other treatment options are exhausted.

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