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,
Curr Rheumatol Rep. 2015 Feb;17(2):7. doi: 10.1007/s11926-014-0481-0.
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.
抗磷脂抗体阳性的患者可能会因毛细血管炎、微血栓形成、抗凝血酶原抗体、血小板减少症和/或过度抗凝治疗而发生出血。患者的临床特征，如肾功能不全、老年或合并用药等，与出血风险密切相关。由于基线血栓形成风险增加，抗磷脂抗体（aPL）阳性患者的出血管理具有挑战性。一旦急性出血得到控制，应尽快重新开始抗凝治疗；在某些情况下，即使存在活动性出血，也可能需要继续抗凝。大剂量皮质类固醇是弥漫性肺泡出血、狼疮抗凝物-低凝血酶原血症综合征和严重血小板减少症的主要治疗方法；为改善长期预后，还需要免疫抑制剂。由于同时存在肾上腺功能不全，氢化可的松对肾上腺出血患者至关重要；尽管有出血，仍应尽可能维持抗凝治疗。对于伴有出血的灾难性抗磷脂综合征患者，应考虑血浆置换。本文将综述 aPL 阳性患者出血的原因及处理策略。
