Hematology 2005 © 2005 The American Society of Hematology. Summary: Even with the most complete datasets, it is still important for the physician to develop a therapeutic plan appropriate for the individual patient, based on clinical presentation, co-morbid conditions, and other variables. With uncommon disorders and limited datasets, such as with the antiphospholipid syndrome, decision-making becomes even more difficult. Table 3 presents a strategy that the author uses when evaluating and developing a treatment plan for a patient with antiphospholipid syndrome and thrombosis, based on the available studies summarized in this article. Critical areas for future research include identifying which patients with antiphospholipid antibodies are at highest risk for thrombotic complications, developing new antithrombotic agents that are effective and safe, and investigating novel approaches to eliminate the autoantibody and, hopefully, the increased prothrombotic state.

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Before the concept of an antiphospholipid syndrome originated, lupus patients with venous occlusions and particularly those with arterial occlusions were treated mainly with corticosteroids and immunosuppressives. In addition, patients with primary APS were often diagnosed as lupus and met classification criteria for this disease. This could have been considered reasonable were it not for the unnecessary steroid treatment they received instead of merely anticoagulant and/or platelet antiaggregant treatment. DONATO ALARCóN-SEGOVIA, MD, MS, PhD. J Rheumatol. VOLUME 30: NO. 9 SEPTEMBER 2003.

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Includes diagnostic algorithm

Management of thrombophilia is an ever-changing field as new disorders are described and additional clinical experience accrues. This paper addresses three common management issues in the care of patients with thrombophilia. The first two topics are updates for common but perplexing hypercoagulable states and the last topic introduces a new option for optimal management of oral anticoagulant therapy. Dr. Jacob Rand updates and organizes the approach to patients with antiphospholipid syndrome. This syndrome is a common acquired thrombophilic state, but the diagnosis and treatment of patients remains a challenge. Dr. Rand outlines his diagnostic and treatment strategies based on the current understanding of this complicated syndrome. Dr. Barbara Konkle addresses the special concerns of managing women with thrombophilia. Hematologists are often asked to advise on the risks of hormonal therapy or pregnancy in a woman with a personal or family history of thrombosis or with an abnormal laboratory finding. Dr. Konkle reviews the available data on the risks of hormonal therapy and pregnancy in women with and without known underlying thrombophilic risk factors. In Section III, Dr. Gail Macik will discuss a new approach to warfarin management. Several instruments are now available for home prothrombin time (PT) monitoring. Self-testing and self management of warfarin are slowly emerging as reliable alternatives to traditional provider-based care and Dr. Macik reviews the instruments available and the results of studies that support this new management option. doi: 10.1182/asheducation-2001.1.322 ASH Education Book January 1, 2001 vol. 2001 no. 1 322-338