Management overview for people with persistent antiphospholipid antibodies and people with antiphospholipid syndrome

Management for people with persistent aPL antibodies [NB2] includes the following:

1. For asymptomatic people with persistent aPL antibodies who are thromboembolism-free, low-dose aspirin is not routinely recommendedErkan, 2007.
2. For asymptomatic people with persistent high-risk aPL-antibody profiles who are thromboembolism-free and trying to conceive, low-dose aspirin may be recommended.
3. For asymptomatic people with systemic lupus erythematosus (SLE) (or other inflammatory connective tissue disease [NB3]) and persistent aPL antibodies who are thromboembolism-free, hydroxychloroquine is the mainstay of therapy; low-dose aspirin may be recommended for primary thromboprophylaxis under specialist advice.

Management for people with known thrombotic antiphospholipid syndrome includes the following:

1. For people with thrombotic antiphospholipid syndrome, based on their first thromboembolic episode, full anticoagulation is required for their thromboembolic episode (with either intravenous unfractionated heparin or subcutaneous low molecular weight [LMW] heparin), followed by lifelong anticoagulation with warfarin (for secondary thromboprophylaxis). A direct-acting oral anticoagulant (DOAC) is not appropriate for the majority of patientsWilliams, 2022.
2. For people with thrombotic antiphospholipid syndrome with recurrent thromboembolic episodes, full anticoagulation is required (as for a first thromboembolic episode). This should be followed by lifelong warfarin, in combination with 1 or more of: low-dose aspirin, dipyridamole plus aspirin, or hydroxychloroquine.

Management for people with known obstetric antiphospholipid syndrome includes the following:

1. For nonpregnant people with a history of obstetric antiphospholipid syndrome only, low-dose aspirin may be considered after assessment of risks versus benefits.Arnaud, 2014Tektonidou, 2019
2. For people with a history of obstetric antiphospholipid syndrome who are trying to conceive or pregnant, specialist management of anticoagulation is recommended throughout preconception, pregnancy and the postpartum period. Ideally, pregnancy should be a planned event, especially for patients with both SLE and antiphospholipid syndromeBranch, 2019Sammaritano, Bermas, 2020Tektonidou, 2019.

Management for people with both thrombotic antiphospholipid syndrome and a history of obstetric antiphospholipid syndrome includes the following:

1. For people with thrombotic antiphospholipid syndrome who develop pregnancy complications [NB4], specialist management is recommended.
2. For people with a history of obstetric antiphospholipid syndrome who develop a first thromboembolic episode [NB4], management is as per patients with a first thromboembolic episode in thrombotic antiphospholipid syndrome.