Despite these limitations, a recent study by Khamashta and associates has given clinicians a firm basis upon which to approach therapy. In aPL-antibody-positive patients with vascular thromboses (DVT, PE, stroke, TIA, etc.) the risk of recurrent thrombotic events is sufficiently high to warrant lifetime anticoagulation with warfarin to maintain an INR of 3.0 or greater. Lower levels of anticoagulation or anticoagulation with aspirin is not as effective. In addition to anticoagulation, other risk factors for thromboembolic events, including hypertension, hypercholesterolemia, and smoking, must be aggressively controlled, and the use of certain estrogen-containing medications in females should be discouraged. The role of steroids and immunosuppressive agents in discouraging disease expression is undetermined. Plasmapheresis has been advocated for use in life-threatening situations. The use of hydroxychloroquine sulfate has been suggested, but there are no studies testing the drug's efficacy in APS. Aspirin alone has been advocated for very-small-vessel disease, including tiny-vessel cerebrovascular disease. The treatment of APS in pregnancy has been the most systematically studied and has been addressed in an earlier section. Aspirin and heparin combinations are the current choice of treatment.
Autoimmune thrombocytopenia is common in APS and is steroid-responsive. Coexistent thrombosis and thrombocytopenia present a major therapeutic dilemma in the anticoagulated patient. Lower levels of anticoagulation have been utilized (INR 2.0-3.0) for platelet counts of 50,000-100,000. When platelet counts fall below 50,000, steroids have been recommended. For steroid-resistant thrombocytopenia other modalities have been tried including danazol, dapsone, chloroquine, and splenectomy. IV gammaglobulin may be helpful in temporarily increasing platelet counts prior to surgical procedures.
Thomas P. Greco, 1997
В итоге - антикоагулянты , в частности варфарин, во время беременности - антикоагулянты без вариантов, и желательно , точнее настоятельно рекомендовать отказаться от препаратов, содержащих половые стероиды , в т.ч. ОК.
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