In general, the most common treatment for antiphospholipid syndrome (APS) is to take anticoagulants, frequently including heparin followed by warfarin. In some cases, anticoagulant therapy may be augmented by low-dose aspirin. Among patients who cannot tolerate aspirin, the anti-platelet clopidogrel may be prescribed.

These anticoagulants and antiplatelets hopefully prevent the formation of blood clots, which may lead to more serious health concerns. Another medication, hydroxychloroquine, is sometimes prescribed. The exact medication, dosage and length of therapy depends on the nature of the APS and any adverse events, such as stroke or deep vein thrombosis, that may have already occurred.

Patients who have recurrent APS, or have experienced blood clot problems already, may be on lifelong anticoagulant medications. These medications require frequent monitoring to reduce the risk of bleeding while gaining maximum benefit. It is also important to eliminate any risk factors for blood clots, such as smoking, uncontrolled high blood pressure and elevated blood cholesterol levels.

Among pregnant women with APS, the therapy depends on the level of antibodies in the blood. Pregnant women with higher antibody levels may be prescribed low-molecular weight heparin in combination with low-dose aspirin during the first and second trimesters to reduce the risk of miscarriage.

Most of the studies dealing with treatment of APS concentrate on patients who have already experienced recurrent effects of the syndrome, such as multiple miscarriages or several episodes of deep vein thrombosis. The treatment of patients without symptoms (asymptomatic) is a related issue, however. Currently, many physicians recommend low-dose aspirin therapy for APS patients who are not allergic to aspirin. This is recommended because even asymptomatic APS patients are at an increased long-term risk for blood clots.

By contrast, patients who suffer from catastrophic APS will need much more intensive therapy, usually beginning with IV heparin, followed by long-term warfarin and glucocorticoid therapy. Additional medications and therapies, including plasma exchange, may be recommended in an effort to bring down the level of antiautobodies present in the blood.

APS patients may also need to take special precautions when having surgery. Whenever a patient undergoes surgery, there is the possibility of blood clot formation during the surgery or recovery period. To reduce the risk of deep vein thrombosis or a pulmonary embolism, anticoagulants may be prescribed, especially after orthopedic procedures on the hip or knee. After surgery, cuffs that inflate intermittently may be wrapped around the patient’s legs to improve circulation and reduce the risk of blood clots. Patients scheduled for surgery should discuss their risk factors with their physician. In addition, performing calf and leg exercises before surgery and resuming activity as soon as possible after surgery can be helpful in blood clot prevention.

Because it is unclear why APS develops, preventive strategies are unknown. However, individuals with APS autoantibodies are encouraged to reduce other risk factors for stroke by controlling blood pressure, monitoring cholesterol levels, maintaining a healthy weight to avoid type 2 diabetes and stopping smoking.