ArticleBlood advances2026
Perioperative management of antithrombotic therapy in patients with thrombotic antiphospholipid syndrome.
Article in Blood advances, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
abstractPatients with thrombotic antiphospholipid syndrome (APS) frequently require interruption of anticoagulation for invasive procedures; however, data to guide the perioperative management remain limited. We conducted a single-center, retrospective cohort study of adults with thrombotic APS who underwent planned periprocedural interruption of anticoagulation between 2016 and 2025. The primary outcomes were the 30-day risks for arterial thromboembolism (ATE), venous thromboembolism, and major bleeding; secondary outcomes included clinically relevant nonmajor bleeding (CRNMB), microvascular APS manifestations, and catastrophic APS (CAPS). Among 172 patients who underwent 282 interruptions, most (84.9%) received warfarin and 25% were triple-positive (anticardiolipin, anti-β2-glycoprotein I, and lupus anticoagulant). Bridging with low-molecular-weight heparin (LMWH) was used in 84.7% of warfarin interruptions. Therapeutic-dose bridging was more frequently used in patients with triple-positive APS (odds ratio [OR], 7.6; 95% confidence interval [CI], 3.2-18.2) and in those with a previous ATE (OR, 3.4; 95% CI, 1.5-7.8). The 30-day risk for ATE was 0.7% (95% CI, 0.2-2.6). Major bleeding occurred in 0.7% (95% CI, 0.2-2.6) of patients with both events following high bleed-risk procedures. One bleeding event was fatal, corresponding to a mortality risk of 0.4% (95% CI, 0.1-2.0). CRNMB occurred in 3.2% (95% CI, 1.7-6.0) of patients. A single case of probable CAPS occurred in a triple-positive patient who received postoperative prophylactic LMWH. Guideline-directed perioperative anticoagulation management tailored to individual thrombotic and procedural bleeding risks seems feasible and safe. Our findings support individualized, risk-adapted perioperative anticoagulation management in APS.
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