Last reviewed: 28 Jun 2021
Last updated: 07 May 2021

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

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.

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