Summary
Definition
History and exam
Key diagnostic factors
- hx or current dx of vascular thrombosis
- hx of pregnancy loss
- hx of pregnancy-associated morbidity
Other diagnostic factors
- hx of SLE
- features of thrombocytopenia
- arthralgia/arthritis
- livedo reticularis
- hx 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
- hx of SLE
- hx of other autoimmune rheumatological disorders
- hx of other autoimmune diseases
- hx of autoimmune haematological disorders
Diagnostic investigations
1st investigations to order
- lupus anticoagulant
- anticardiolipin antibodies
- anti-beta2-glycoprotein I antibodies
- ANA, 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
- thrombophilia screen
Treatment algorithm
Contributors
Authors
Consultant Haematologist
Guys and St. Thomas' Foundation Trust
London
UK
Disclosures
KAB has received honoraria/speakers' fees from Bayer and Boehringer Ingelheim, and a grant from Sanofi Aventis.
Professor of Thrombosis and Haemostasis
King's College
Guys and St. Thomas' Foundation Trust
London
UK
Disclosures
BJH is a principal investigator in a trial of rivaroxaban in antiphospholipid syndrome which had a grant from Arthritis & Rheumatism Council and free drug from Bayer. BJH is Medical Director of Thrombosis UK.
Peer reviewers
Consultant Rheumatologist
BHRT University Hospital
Queen’s Hospital
Romford
UK
Disclosures
KC declares that he has no competing interests.
Staff Hematologist
Cleveland Clinic Taussig Cancer Center
Cleveland
OH
Disclosures
AL declares that he has no competing interests.
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