Antiphospholipid Syndrome Follow-up

  • Author: Elise Belilos, MD; Chief Editor: Herbert S Diamond, MD   more...
 
Updated: Jan 19, 2012
 

Further Inpatient Care

  • Intensive observation is warranted for patients with CAPS.
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Further Outpatient Care

  • Carefully monitor medication doses and the INR if applicable.
  • Closely observe the patient for clinical events.
  • Ensure the care of any underlying connective-tissue disease.
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Inpatient & Outpatient Medications

  • The suggested medications include heparin, warfarin, aspirin, and, in selected cases, hydroxychloroquine, intravenous immunoglobulin, and corticosteroids.
  • Corticosteroids are rarely used for the treatment of recurrent fetal loss because of the increased risk of maternal morbidity. Generally, the use of corticosteroids is reserved for specific nonthrombotic manifestations, such as associated thrombocytopenia, autoimmune hemolytic anemia, or the treatment of an underlying connective-tissue disease.
  • Prescribe antihypertensive drugs when necessary.
  • Administer antihyperlipidemic agents including statins when appropriate.
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Transfer

  • When treating seriously ill patients with CAPS, transfer the patient to a setting where plasma exchange can be performed or where intravenous immunoglobulin or cyclophosphamide can be administered if needed.
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Deterrence/Prevention

  • 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.
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Complications

  • Permanent functional disability or death can occur at a relatively young age. Complications may include the following:
    • Cerebrovascular accident
    • MI
    • Pulmonary hypertension
    • Renal failure[17]
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Prognosis

  • With appropriate medication and lifestyle modifications, most individuals with primary antiphospholipid syndrome (APS) lead normal healthy lives. However, subsets of patients continue to have thrombotic events despite aggressive therapies. In these patients and in patients with CAPS, the disease course can be devastating, often leading to significant morbidity or early death.
  • A retrospective study suggested that hypertension or medium-to-high titers of IgG anticardiolipin antibody are risk factors for a first thrombotic event in asymptomatic patients with antiphospholipid (aPL) antibodies.[18] Primary prophylaxis against thrombosis appears to offer significant protection in such cases.
  • Patients with secondary APS carry a prognosis similar to that of patients with primary APS; in the former, however, morbidity and mortality may also be influenced by these patients' underlying autoimmune or rheumatic condition. In patients with SLE and APS, aPL antibodies have been associated with neuropsychiatric disease and have been recognized as a major predictor of irreversible organ damage.
  • Women with aPL antibodies who experience recurrent miscarriages may have favorable prognoses in subsequent pregnancies if treated with aspirin and heparin.
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Patient Education

  • Stress the importance of early recognition of a possible clinical event.
  • Educate the patient about anticoagulation therapy.
  • Discuss the importance of planned pregnancies so that long-term warfarin can be switched to aspirin and heparin before pregnancy is attempted.
  • For excellent patient education resources, visit eMedicine's Circulatory Problems Center. Also, see eMedicine's patient education article Blood Clot in the Legs.
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Contributor Information and Disclosures
Author

Elise Belilos, MD  Section Head of Rheumatology, Division of Rheumatology, Allergy and Immunology, Winthrop-University Hospital; Assistant Professor of Clinical Medicine, Department of Internal Medicine, State University of New York at Stony Brook

Elise Belilos, MD is a member of the following medical societies: American College of Rheumatology and Arthritis Foundation

Disclosure: Nothing to disclose.

Coauthor(s)

Steven Carsons, MD  Chief, Division of Rheumatology, Allergy, and Immunology, Professor of Medicine, Department of Internal Medicine, Winthrop University Hospital, State University of New York at Stony Brook

Steven Carsons, MD is a member of the following medical societies: American College of Rheumatology, New York Academy of Sciences, and Society for Experimental Biology and Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Carlos J Lozada, MD  Director of Rheumatology Fellowship Program, Professor, Department of Medicine, Division of Rheumatology and Immunology, University of Miami, Leonard M Miller School of Medicine

Carlos J Lozada, MD is a member of the following medical societies: American College of Physicians and American College of Rheumatology

Disclosure: Pfizer Honoraria Speaking and teaching; Amgen Honoraria Speaking and teaching

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Lawrence H Brent, MD  Associate Professor of Medicine, Jefferson Medical College of Thomas Jefferson University; Chair, Program Director, Department of Medicine, Division of Rheumatology, Albert Einstein Medical Center

Lawrence H Brent, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Immunologists, American College of Physicians, and American College of Rheumatology

Disclosure: Abbott Honoraria Speaking and teaching; Centocor Consulting fee Consulting; Genentech Grant/research funds Other; HGS/GSK Honoraria Speaking and teaching; Omnicare Consulting fee Consulting; Pfizer Honoraria Speaking and teaching; Roche Speaking and teaching; Savient Honoraria Speaking and teaching; UCB Honoraria Speaking and teaching

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD  Adjunct Professor of Medicine, Division of Rheumatology, University of Pittsburgh School of Medicine; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital

Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, and Phi Beta Kappa

Disclosure: Merck Ownership interest Other; Smith Kline Ownership interest Other; Zimmer Ownership interest Other

Additional Contributors

The authors gratefully acknowledge the contributions of Amiel Tokayer, MD.

References

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