The Curbsiders Internal Medicine Podcast #421 Antiphospholipid Syndrome with Dr. Arielle Langer
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Jan 8, 2024 Dr. Arielle Langer, an expert in antiphospholipid syndrome, discusses clinical features, laboratory testing, and management of the syndrome. Topics include suspicion for antiphospholipid syndrome, interpreting laboratory testing, managing recurrent thrombosis, and obstetric APLS. The challenges of diagnosing APS based on pregnancy history are also explored. Importance of referring patients to specialists and promoting support is emphasized.
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Inflammation Drives Transient Positives
- Inflammatory states commonly cause transient antiphospholipid antibody positivity, creating many false positives.
- Labs done during acute illness are unreliable for diagnosing true persistent APS.
Applying Classification Criteria
- Use the Sapporo (Sydney) criteria: clinical thrombosis plus lab positivity (titers >40) persistently at 12 weeks to classify APS.
- If triple-positive with a convincing thrombotic event, start treatment while awaiting 12-week confirmation.
Get Lupus Anticoagulant Before Anticoagulation
- Draw a lupus anticoagulant specimen before starting anticoagulation when APS is suspected so you have an uncontaminated baseline.
- If already on warfarin, consider repeating off anticoagulation later or involve hematology for interpretation.