How should a patient with Antiphospholipid Antibodies and no previous history of thrombosis be treated if they are undergoing a high risk procedure?
Asymptomatic patients (particularly those with high-risk profile) should receive prophylactic treatment to prevent clots when undergoing high-risk procedures even if they have no previous history of clot. All should get compression stockings and early ambulation. In addition, the following recommendations ( J Rheumatol 29:843, 2002) should be continued at least 1 week (low risk) to 6 weeks (high risk) postoperative or postpartum depending on thrombotic versus bleeding risks:
• General surgery: low-dose unfractionated heparin: 5000 units subcutaneous (SC) q8 to q12 hours starting 1 to2 hours before surgery; or LMWH such as enoxaparin 30 mg SC q12 hours starting 12 to 24 hours after surgery, or 40 mg SC q24 hours starting 1–2 hours before surgery.
• Orthopedic surgery: low-dose unfractionated heparin: 5000 units SC q8 to q12 hours starting 12 to 24 hours after surgery; or LMWH such as enoxaparin 30 mg SC q12 hours starting 12 to 24 hours after surgery, or 40 mg q24 hours starting 10 to 12 hours before surgery.
• Pregnancy: during pregnancy, patients should receive ASA (81–325 mg daily). Postpartum patients should get prophylactic dose LMWH described earlier for general surgery prophylaxis.
