Current recommendations for treatment of a patient with Antiphospholipid Antibodies who has never had a clot or a previous pregnancy complication (primary thrombosis prevention)?
• Although controversial, the APLASA study (Arth Rheum 56:2382, 2007) showed no benefit from low-dose aspirin (ASA) in otherwise asymptomatic patients with aPL abs. Therefore, low-risk patients should not receive ASA.
• Asymptomatic patients with aPL abs who are at high risk for clots should receive low-dose ASA (81 mg daily). Patients who have not had a previous clot but are at high risk for clots in the future include: (1) triple positive aPL abs; (2) LA or high-titer anti-β2GPI abs; (3) SLE patients; or (4) calculated 10-year cardiovascular disease risk ≥10%. SLE patients may also lessen clot risk due to the mild antithrombotic effect of hydroxychloroquine (HCQ) therapy.
• All patients should have modifiable risk factors treated: smoking, lipids, hypertension, diabetes mellitus, immobilization, birth control pills.
• Asymptomatic high-risk patients with aPL abs who will be going on an airplane flight lasting > 4-8 hours should receive one prophylactic dose of LMWH before the flight.
They should also be asked to ambulate and do calf exercises during the flight.
