Abstract
Thrombocytopenia is one of the most common manifestations of antiphospholipid syndrome
(APS). There is little evidence or definitive guidelines regarding the treatment of
APS with thrombocytopenia. We describe a patient with APS and moderate-to-severe thrombocytopenia
and the challenges of balancing anticoagulation with thrombocytopenia. A 19-year-old
male patient presented with right lower limb swelling to the emergency department
with a history of gradually worsening right leg swelling for 1 week and was diagnosed
with right leg proximal deep vein thrombosis. Ultrasound Doppler of the right lower
limb revealed complete venous thrombosis from the level of the popliteal vein to the
distal superficial femoral vein. Subsequently, he was found to have triple-positive
APS and moderate-to-severe immune thrombocytopenia, with a platelet count nadir of
31 × 10 to the ninth power/L. He was started on anticoagulation with warfarin. The
severe thrombocytopenia was not treated with immunosuppressants and the platelets
fluctuated in the range of moderate-to-severe thrombocytopenia but did not develop
any rethrombotic or bleeding events. His platelets varied from 31 × 10 to the ninth
power/L to 106 × 10 to the ninth power/L. This case report demonstrates that it may
be safe to hold off treatment for thrombocytopenia in APS, even in cases of severe
thrombocytopenia. Treatment with immunosuppressants may be instituted only when platelet
levels fall below 20 × 10 to the ninth power/L or when there is clinically significant
bleeding, as in primary immune thrombocytopenia.
Keywords
DVT - anticoagulation - thrombophilia - deep vein thrombosis - lower - low-molecular-weight
heparin - disease
