Antiphospholipid Syndrome Updated: Sep 30, 2018 Author: Suneel Movva, MD; Chief Editor: Herbert S Diamond, MD Presentation and Workup. Multiple terms for APS exist. Unfortunately, some synonyms can be confusing. lupus anticoagulant (LA) syndrome, for example, is misleading—first, because patients with APS may not necessarily have systemic lupus erythematosus (SLE), and second, because although LAs do have an anticoagulant effect in vitro, LA syndrome manifests clinically with thrombotic rather than hemorrhagic complications. In an attempt to avoid further confusion, APS is currently the preferred term for the clinical syndrome (as described below). Some patients with APS have no evidence of any definable associated disease, while, in other patients, APS occurs in association with SLE or another rheumatic or autoimmune disorder. Traditionally, these have been referred to as primary or secondary APS, respectively. Currently, however, the preferred terminology is APS with or without associated rheumatic disease. Although antiphospholipid (aPL) antibodies are clinically linked to APS, whether they are involved in the pathogenesis or are an epiphenomenon is unclear. (Up to 5% of healthy individuals are known to have aPL antibodies.) In general, treatment regimens for APS must be individualized according to the patient's current clinical status and history of thrombotic events. Asymptomatic individuals in whom blood test findings are positive do not require specific treatment. Prophylaxis is needed during surgery or hospitalization, as well as management of any associated autoimmune disease. Low-dose aspirin is used widely in this setting; although its effectiveness remains unproven. For thrombosis, perform full anticoagulation with intravenous or subcutaneous heparin followed by warfarin therapy. See Treatment. For discussion of APS in children, see Pediatric Antiphospholipid Antibody Syndrome. For discussion of obstetric APS, see Antiphospholipid Syndrome and Pregnancy.
