Diagnosis and management of antiphospholipid syndrome

Antiphospholipid syndrome is an autoimmune disease characterised by thrombotic and/or obstetric manifestations with persistent antiphospholipid antibodies. Diagnosis involves confirming the persistence of antiphospholipid antibodies in symptomatic patients, using validated classification criteria as a guide. The likelihood of obtaining falsepositive or false-negative test results in certain settings, and the lack of standardisation between laboratory methods, are important considerations. Patients who have had thrombotic manifestations require lifelong anticoagulation from the first thrombotic event, typically with warfarin. Patients with a history of thrombotic and/or obstetric manifestations who become pregnant should receive low-molecular-weight heparin and low-dose aspirin during pregnancy and postpartum. Testing asymptomatic people is not recommended, except in the context of systemic lupus erythematosus. Management of asymptomatic people with persistent antiphospholipid antibodies depends on their individual antibody profile and risk factors.