In antiphospholipid syndrome with recurrent strokes, would you consider adding antiplatelets to warfarin?
Also how would you manage this perioperatively?
Answer from: at Academic Institution
I agree with Dr. @Andras Perl. I have had patients with APS and recurrent thromboembolic events although not necessarily strokes to whom I have added aspirin and HCQ to the treatment regimen. I did this because she continued to have recurrent events. However, there is at least one article that negat...
Comments
at SUNY Upstate Medical University Indeed, in such APS patients who fail to respond t...
Medical Oncologist at Cancer Care Specialists/Renown Oncology/UNR If APLA is well controlled on HCQ, can we de-escal...
Medical Oncologist at Millennium Onc If triple positive means aCL Ab and lupus anticoag...
This is a good question, especially noting the high rate of recurrent thrombotic events in non-treated patients with antiphospholipid syndrome (up to 29% if untreated, but still significant among treated patients, especially after an arterial event).
Edit: to jump to the punchline, I favor adding A...
Agree with Dr. @Andras Perl. There are limited data addressing this issue. The original guidelines published in Stroke a number of years back suggested that aspirin monotherapy was sufficient for secondary prophylaxis. However, most rheumatologists felt that was insufficient; especially since the pa...
Answer from: Medical Oncologist at Community Practice
No addition of ASA to "well anticoagulated" patient -- may need to assess Factor II activity to make sure it is less than 20% for adequate inhibition of hemostasis.
There have been so many attempts to use various "antiplatelet drugs" over the past 5 decades, in various thrombophilic conditi...
Indeed, in such APS patients who fail to respond t...
If APLA is well controlled on HCQ, can we de-escal...
If triple positive means aCL Ab and lupus anticoag...