Anticardiolipin Positive; How long to anticoagulate? - USMLE Forums
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Old 05-25-2012
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Blood Anticardiolipin Positive; How long to anticoagulate?

A 42-year-old woman is evaluated for swelling and discomfort of the right leg without an obvious precipitating event. She has no other medical problems. On physical examination, vital signs are normal. Examination of the right lower extremity
shows mild erythema, swelling, warmth, and tenderness to deep palpation of the calf. Cardiopulmonary and abdominal examination findings are normal.
Laboratory studies indicate a moderately elevated IgG anticardiolipin antibody level and the presence of a lupus inhibitor on coagulation testing. An ultrasound shows a right proximal lower extremity deep venous thrombosis.
The patient is treated with anticoagulation therapy. Repeat anticardiolipin antibody testing 12 weeks later confirms the previous result.
Which of the following is the most appropriate anticoagulation management for this patient?

(A) Anticoagulation therapy indefinitely
(B) Anticoagulation therapy for a total of 12 months
(C) Anticoagulation therapy for a total of 6 months
(D) Cessation of anticoagulation therapy at 3 months
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Old 05-25-2012
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This is the first time that the pt developed dvt so i will go with 6mo first
I this recur then lifelong rx is needed
This rule is usually applies for idiopathic dvt, but in antiphospholipid synd the evidence is controversial still i think
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Old 05-25-2012
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Quote:
Originally Posted by tyagee View Post
A 42-year-old woman is evaluated for swelling and discomfort of the right leg without an obvious precipitating event. She has no other medical problems. On physical examination, vital signs are normal. Examination of the right lower extremity
shows mild erythema, swelling, warmth, and tenderness to deep palpation of the calf. Cardiopulmonary and abdominal examination findings are normal.
Laboratory studies indicate a moderately elevated IgG anticardiolipin antibody level and the presence of a lupus inhibitor on coagulation testing. An ultrasound shows a right proximal lower extremity deep venous thrombosis.
The patient is treated with anticoagulation therapy. Repeat anticardiolipin antibody testing 12 weeks later confirms the previous result.
Which of the following is the most appropriate anticoagulation management for this patient?

(A) Anticoagulation therapy indefinitely
(B) Anticoagulation therapy for a total of 12 months
(C) Anticoagulation therapy for a total of 6 months
(D) Cessation of anticoagulation therapy at 3 months
(B) Anticoagulation therapy for a total of 12 months

http://bloodjournal.hematologylibrar...01/5/1827.long

Quote:
Lupus anticoagulants have an odds ratio for thrombosis 5 to 16
times higher than controls. These figures are very close to those
reported by Wahl and coworkers for deep vein thrombosis in
patients with and without systemic lupus erythematosus. They
are also similar to and, in some instances, even higher than in
patients with genetically determined risk factors for venous thrombosis.

Unlike these conditions, lupus anticoagulants increase the
risk of venous and arterial events to the same extent, particularly if
cerebral stroke and deep vein thrombosis are considered.
Anticardiolipin antibodies are not such strong risk factors for
thrombosis as lupus anticoagulants, and only 50% of their associations with thrombosis
reached statistical significance. Separate analysis of the different types of thrombosis showed anticardiolipin
antibodies were associated with cerebral stroke and myocardial
infarction but not with deep vein thrombosis.
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Old 05-26-2012
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Quote:
Originally Posted by tyagee View Post
A 42-year-old woman is evaluated for swelling and discomfort of the right leg without an obvious precipitating event. She has no other medical problems. On physical examination, vital signs are normal. Examination of the right lower extremity
shows mild erythema, swelling, warmth, and tenderness to deep palpation of the calf. Cardiopulmonary and abdominal examination findings are normal.
Laboratory studies indicate a moderately elevated IgG anticardiolipin antibody level and the presence of a lupus inhibitor on coagulation testing. An ultrasound shows a right proximal lower extremity deep venous thrombosis.
The patient is treated with anticoagulation therapy. Repeat anticardiolipin antibody testing 12 weeks later confirms the previous result.
Which of the following is the most appropriate anticoagulation management for this patient?

(A) Anticoagulation therapy indefinitely
(B) Anticoagulation therapy for a total of 12 months
(C) Anticoagulation therapy for a total of 6 months
(D) Cessation of anticoagulation therapy at 3 months
-ithink it ,A
-REFERANCE SAY:it depend on pt condition,but at LEAST 12 MONTHS( i.e12month+or=),and also indefinte therapy is indicated(adjust to pt condition).
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Old 05-26-2012
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life long Rx.

last line of pg 235 MTB 2
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Old 05-26-2012
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Quote:
Originally Posted by mbbs2010 View Post
life long Rx.

last line of pg 235 MTB 2
MTB Treat with Hep & war as you would for any cause of DVT or PE (that mean for 6 month or 12 or lifelong ? )
APL synd MAY require lifelong anticogulation (that mean not from first time)

wiki Treatment for a lupus anticoagulant is usually undertaken in the context of documented thrombosis, such as extremity phlebitis or dural sinus vein thrombosis. Patients with a well-documented (i.e., present at least twice) lupus anticoagulant and a history of thrombosis should be considered candidates for indefinite treatment with anticoagulants. Patients with no history of thrombosis and a lupus anticoagulant should probably be observed.
what about the first time WIKI

Last edited by bisho; 05-26-2012 at 10:25 AM.
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