Summary
Definition
History and exam
Key diagnostic factors
- history or current diagnosis of vascular thrombosis
- history of pregnancy loss
- history of pregnancy-associated morbidity
Other diagnostic factors
- history of systemic lupus erythematosus
- features of thrombocytopenia
- arthralgia/arthritis
- livedo reticularis
- history of other rheumatological disorders or connective tissue disorders
- cardiac murmur
- oedema
- seizure, headache, memory loss, signs of transverse myelopathy
- limb discomfort, swelling, skin discoloration, and ulcers
Risk factors
- history of systemic lupus erythematosus
- history of other autoimmune rheumatological disorders
- history of other autoimmune diseases
- history of autoimmune haematological disorders
Diagnostic investigations
1st investigations to order
- lupus anticoagulant
- anticardiolipin antibodies
- anti-beta2-glycoprotein I antibodies
- antinuclear antibody, double-stranded DNA, and extractable nuclear antigen antibodies
- FBC
- creatinine and urea
Investigations to consider
- venous Doppler ultrasound
- venography or MRI
- MRI of thrombosis
- CT angiogram of the chest
- ventilation-perfusion (V/Q) scan
- cranial MRI
- echocardiography
- inherited thrombophilia test
Treatment algorithm
non-pregnant with acute thrombosis
pregnant
catastrophic APS (pregnant or non-pregnant)
incidental antiphospholipid antibodies
Contributors
Authors
Karen A. Breen, MB, MRCPI
Consultant Haematologist
Guys and St. Thomas' Foundation Trust
London
UK
Disclosures
KAB has performed consultancy work for Bayer/Pfizer.
Beverley J. Hunt, MD, FRCP, FRCPath
Professor of Thrombosis and Haemostasis
King's College
Guys and St. Thomas' Foundation Trust
London
UK
Disclosures
BJH is Medical Director of Thrombosis UK and chair of the steering committee for World Thrombosis Day. BJH is an author of a reference cited in this topic.
Peer reviewers
Kuntal Chakravarty, FRCP (London), FRCP (Glasgow), FRCP (Ireland), FACP (USA), FACR (USA)
Consultant Rheumatologist
BHRT University Hospital
Queen’s Hospital
Romford
UK
Disclosures
KC declares that he has no competing interests.
Alan Lichtin, MD
Staff Hematologist
Cleveland Clinic Taussig Cancer Center
Cleveland
OH
Disclosures
AL declares that he has no competing interests.
Differentials
- Sneddon's syndrome
- Inherited thrombophilia
More DifferentialsGuidelines
- Addendum to British Society for Haematology Guidelines on Investigation and Management of Antiphospholipid syndrome, 2012 (Br. J. Haematol. 2012; 157: 47–58): use of direct acting oral anticoagulants
- EULAR recommendations for the management of antiphospholipid syndrome in adults
More GuidelinesPatient leaflets
Deep vein thrombosis
Miscarriage
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