The Fellow on Call: The Heme/Onc Podcast
Episode 135: VTE Series - Management of Antiphospholipid Antibody Syndrome
May 7, 2025
Delve into the management of antiphospholipid antibody syndrome with insights on anticoagulants. Discover if a higher INR is indeed better for warfarin and explore the role of Direct Oral Anticoagulants. The hosts debate the optimal timing for APLS testing—don't miss their lively back-and-forth! A recent trial sheds light on transitioning patients from warfarin to rivaroxaban, scrutinizing its findings. Plus, learn about the comparative effects of apixaban and warfarin in this complex treatment landscape.
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Quick takeaways
- Warfarin remains the gold standard for anticoagulation in antiphospholipid antibody syndrome patients due to its superior safety profile compared to DOACs.
- The timing of antiphospholipid antibody syndrome testing during hospitalization raises debate between immediate diagnosis to prevent strokes and the risk of overdiagnosis.
Deep dives
Understanding Antiphospholipid Antibody Syndrome
Antiphospholipid antibody syndrome (APLS) is characterized by the presence of specific antibodies that can lead to increased risk of thrombotic events. Diagnosis requires at least two positive tests for antiphospholipid antibodies separated by 12 weeks, along with clinical criteria for thrombosis or obstetric complications. The discussion highlights a case involving a young woman diagnosed with APLS after presenting with a pulmonary embolism, marking the importance of a thorough hypercoagulability workup. Positive testing for anticardiolipin IgM antibodies and the nuances in interpreting antibody results are crucial in making a proper diagnosis.
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