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Monitoring of anticoagulation in thrombotic antiphospholipid syndrome

Cohen, H; Efthymiou, M; Devreese, KMJ; (2021) Monitoring of anticoagulation in thrombotic antiphospholipid syndrome. Journal of Thrombosis and Haemostasis , 19 (4) pp. 892-908. 10.1111/jth.15217. Green open access

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Abstract

Anticoagulation is central to the management of thrombotic antiphospholipid syndrome (APS). The standard anticoagulant treatment for thrombotic APS is life-long warfarin or an alternative vitamin K antagonist. The role of direct oral anticoagulants for thrombotic APS is not established due to the lack of definitive evidence and has recently been addressed in international guidance. Other anticoagulant options include low-molecular-weight heparin, unfractionated heparin and fondaparinux. In APS patients, lupus anticoagulant can affect phospholipid-dependent coagulation monitoring tests, so that they may not reflect true anticoagulation intensity. Accurate assessment of anticoagulation intensity is essential, to optimise anticoagulant dosing and facilitate thrombus resolution; minimise the risk of recurrent thrombosis or bleeding; inform assessment of whether recurrent thrombosis is related to breakthrough thrombosis while on therapeutic anticoagulation, subtherapeutic anticoagulation, non-adherence or spurious results; and guide the management of bleeding. Knowledge of anticoagulant intensity also informs assessment and comparison of anticoagulation regimens in clinical studies. Considerations regarding anticoagulation dosing and/or monitoring of thrombotic APS patients underpin appropriate management in special situations, notably APS-related severe renal impairment, that may occur in APS or APS/systemic lupus erythematosus-related nephropathy or catastrophic APS; and APS-related thrombocytopenia. Anticoagulant dosing and monitoring in thrombotic APS patients also requires consideration in anticoagulant-refractory APS and pregnancy. In this review, we summarise the tests generally used in monitoring anticoagulant therapy, use of the main anticoagulants considered for thrombotic APS, lupus anticoagulant effects on anticoagulation monitoring tests, and strategies for appropriate anticoagulant monitoring in thrombotic APS.

Type: Article
Title: Monitoring of anticoagulation in thrombotic antiphospholipid syndrome
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/jth.15217
Publisher version: http://dx.doi.org/10.1111/jth.15217
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: anticoagulant monitoring, chromogenic anti-Xa/anti-IIa, chromogenic factor X, prothrombin time-international normalised ratio, thrombin generation, thrombotic antiphospholipid syndrome
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute > Research Department of Haematology
URI: https://discovery.ucl.ac.uk/id/eprint/10118473
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