Diagnosis

If you have one or more episodes of thrombosis or pregnancy loss that aren't explained by known health conditions, your doctor can schedule blood tests to check for abnormal clotting and for the presence of antibodies to phospholipids.

To confirm a diagnosis of antiphospholipid syndrome, the antibodies must appear in your blood at least twice, in tests conducted 12 or more weeks apart.

Treatment

Doctors generally use medications that reduce your blood's tendency to clot to help prevent complications of antiphospholipid syndrome.

Standard initial treatment

If you have thrombosis, standard initial treatment involves a combination of blood-thinning (anticoagulant) medications.

  • Heparin. Typically, you'll first be given an injection of the blood thinner heparin, combined with another blood thinner in pill form, likely warfarin (Coumadin, Jantoven).
  • Warfarin. After several days of combined heparin and warfarin, your doctor might discontinue the heparin and continue the warfarin, possibly for the rest of your life.
  • Aspirin. In some cases, your doctor might recommend adding low-dose aspirin to your treatment plan.

When you're taking anticoagulant medication, you have an increased risk of bleeding episodes. Your doctor will monitor your dosage with blood tests to be sure your blood is capable of clotting enough to stop the bleeding of a cut or the bleeding under the skin from a bruise.

Treatment during pregnancy

During pregnancy, treatment to keep your blood from clotting increases your chances of carrying to term. Treatment includes:

  • Heparin. Some forms of heparin — enoxaparin (Lovenox) and dalteparin (Fragmin) — are known as low-molecular-weight heparin, which you can inject yourself under your skin (subcutaneously). Heparin is considered safe to take during pregnancy.
  • Aspirin. If you're pregnant, your doctor might recommend taking one tablet of aspirin daily in addition to the heparin, to increase your chances of a successful pregnancy.

Possible future treatments

Several new treatments are being considered for antiphospholipid syndrome, including:

  • New blood thinners (anticoagulants). A number of oral blood thinners — dabigatran (Pradaxa), rivaroxaban (Xarelto) and apixaban (Eliquis) — have recently been approved to treat other conditions. It's not clear yet if these drugs are appropriate for treating antiphospholipid syndrome. None is recommended for use during pregnancy or breast-feeding.
  • Rituximab (Rituxan). This drug has been used successfully to treat conditions affecting the immune system. But there isn't yet enough evidence of benefit to recommend rituximab as a treatment for antiphospholipid syndrome.

Lifestyle and home remedies

Depending on your treatment plan for antiphospholipid syndrome, there are additional steps you can take to protect your health.

If you take anticoagulants

Take extra care to keep from injuring yourself and to avoid bleeding.

  • Avoid contact sports or other activities that could cause bruising or injury or cause you to fall.
  • Use a soft toothbrush and waxed floss.
  • Shave with an electric razor.
  • Take extra care when using knives, scissors and other sharp tools.

Certain foods and medications may affect how well your anticoagulants work. Ask your doctor for guidance about:

  • Safe dietary choices. Vitamin K can lessen the effectiveness of warfarin, but not other anticoagulants. Eating small amounts of vitamin K-rich foods might not be harmful, but avoid eating large amounts of avocado, broccoli, Brussels sprouts, cabbage, leafy greens and garbanzo beans.

    On the other hand, cranberry juice and alcohol can increase warfarin's blood-thinning effect. Ask your doctor if you need to limit or avoid these drinks.

  • Safe medications and dietary supplements. Certain medications, vitamins and herbal products can interact dangerously with warfarin. These include some over-the-counter pain relievers, cold medicines, stomach remedies or multivitamins, as well as garlic, ginkgo and green tea products.

Preparing for your appointment

In most cases, complications of antiphospholipid syndrome — such as DVT, stroke or pregnancy loss — will prompt you to seek medical care. Depending on your complication, you'll likely see a specialist in vascular disease, obstetrics or hematology.

Here's some information to help you get ready for your appointment.

What you can do

Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance. Make a list of:

  • Your signs or symptoms and when they began.
  • Write down key personal information, including any major recent events or changes in your life.
  • Key medical information, including other conditions or infections you have and family medical history, especially close relatives who've had antiphospholipid syndrome.
  • All medications, vitamins and other supplements you take, including doses.
  • Questions to ask your doctor.

Take a family member or friend along, if possible, to help you remember the information you get.

For antiphospholipid syndrome, some questions to ask your doctor include:

  • What's the most likely cause of my symptoms?
  • What tests do I need?
  • What treatment do you recommend?
  • How will you determine whether my treatment is working?
  • Does this condition increase my risk of any other medical problems?
  • Does this condition increase my risk of health problems during pregnancy? Are there treatments to reduce that risk?
  • Are there brochures or other printed material that I can have? What websites do you recommend?

Don't hesitate to ask other questions, as well.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

  • Do you have a history of stroke or blood clots?
  • Do you have a history of pregnancy complications, such as high blood pressure, miscarriage or stillbirth?
  • Do you have lupus or another autoimmune disorder?
  • Have you ever been tested for sexually transmitted infections or chronic viral diseases, such as hepatitis?
  • Do you have frequent headaches?
  • Have you noticed a red, net-like rash on your wrists or knees?
  • Do you smoke?
Feb. 09, 2017
References
  1. Antiphospholipid antibody syndrome? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/aps/. Accessed Nov. 28, 2016.
  2. Erkan D, et al. Clinical manifestations of antiphospholipid syndrome. http://www.uptodate.com/home. Accessed Nov. 28, 2016.
  3. Antiphospholipid syndrome. American College of Rheumatology. http://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Antiphospholipid-Syndrome. Accessed Nov. 28, 2016.
  4. Schur PH, et al. Treatment of the antiphospholipid syndrome. http://www.uptodate.com/home. Accessed Nov. 28, 2016.
  5. Lockwood CJ, et al. Pregnancy in women with antiphospholipid syndrome. http://www.uptodate.com/home. Accessed Nov. 28, 2016.
  6. Blood thinner pills: Your guide to using them safely. Rockville, Md.: Agency for Healthcare Research and Quality. http://www.ahrq.gov/patients-consumers/diagnosis-treatment/treatments/btpills/btpills.html. Accessed Nov. 29, 2016.
  7. Ask Mayo Expert. Warfarin: Dietary recommendations (adult). Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2016.
  8. Dlott JS, et al. Drug-induced lupus anticoagulants and antiphospholipid antibodies. Current Rheumatology Reports. 2012;14:71.

Antiphospholipid syndrome