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The Challenge of Bleeding in Antiphospholipid Antibody-Positive Patients

  • Antiphospholipid Syndrome (D Erkan, Section Editor)
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Abstract

Antiphospholipid antibody-positive patients can develop bleeding due to capillaritis, microthrombosis, antiprothrombin antibodies, thrombocytopenia, and/or excessive antithrombotic therapy. Clinical characteristics of patients, e.g., renal impairment, elderly, or concomitant medications, are closely related to the risk of bleeding. The management of bleeding in antiphospholipid antibody (aPL)-positive patients is challenging due to the baseline increased risk of thrombosis. If anticoagulation is stopped, it should be restarted as soon as possible once the acute bleeding is controlled; the continuation of anticoagulation despite active bleeding may be required in selected cases. High-dose corticosteroid is the mainstay treatment for diffuse alveolar hemorrhage, lupus anticoagulant–hypoprothrombinemia syndrome, and severe thrombocytopenia; immunosuppressive drugs are also required to improve the long-term outcomes. Hydrocortisone is critical in adrenal hemorrhage patients due to concomitant adrenal insufficiency; despite bleeding, anticoagulation should be maintained as much as possible. Plasma exchange should be considered in catastrophic antiphospholipid syndrome patients with concurrent bleeding. This article will review the causes of bleeding in aPL-positive patients as well as the management strategies.

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Acknowledgement

The authors wish to thank Michael D. Lockshin, MD, for the critical review of the manuscript.

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Conflict of Interest

Giulia Pazzola and Stéphane Zuily declare no conflict of interest.

Doruk Erkan reports grants from Lupus Clinical Trials Consortium, New York Community Trust, EMD Serono, and from NIH, as well as grants and personal fees from Alexion, outside the submitted work.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera Arcispedale S Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Viale Risorgimento n 80, 42100, Reggio Emilia, Italy

    Giulia Pazzola

  2. Vascular Medicine Division and Regional Competence Centre For Rare Vascular And Systemic Autoimmune Diseases, CHU Nancy, Rue du Morvan, 54511, Vandoeuvre-lès-Nancy Cedex, France

    Stéphane Zuily

  3. Barbara Volcker Centre for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY, 10021, USA

    Doruk Erkan

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  1. Giulia Pazzola
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Correspondence to Doruk Erkan.

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This article is part of the Topical Collection on Antiphospholipid Syndrome

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Pazzola, G., Zuily, S. & Erkan, D. The Challenge of Bleeding in Antiphospholipid Antibody-Positive Patients. Curr Rheumatol Rep 17, 7 (2015). https://doi.org/10.1007/s11926-014-0481-0

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