Abstract Number: PO192
Meeting: ISTH 2021 Congress
Background: Antiphospholipid syndrome (APS) is characterized by a high incidence of recurrent venous or arterial thrombosis and obstetric morbidity. Conventional anticoagulation therapy may be ineffective in antithrombotic prophylaxis. It remains an issue in the management of APS. Hydroxychloroquine (Plaquenil) is reported to reduce antiphospholipid antibody titers in patients with antiphospholipid syndrome and to improve pregnancy outcomes. Several data suggest the role of Hydroxychloroquine in lowering incidence of thromboembolic events in patients with persistently elevated levels of antiphospholipid antibodies.
Aims: To decrease events of recurrent thrombosis, to show the efficacy of Hydroxychloroquine in prophylaxis of recurrent thrombosis in patients with antiphospholipid syndrome.
Methods: The patient is a 22-year-old primigravida, at the gestational age of 10 weeks, with a history of thrombotic episodes, homocysteinemia, and antiphospholipid syndrome.
She was diagnosed with deep vein thrombosis of the legs a few years ago. Anticoagulation treatment was initiated with Low-molecular-weight heparin (LMWH) and Rivaroxaban. Within a year after the first thrombotic episode re-thrombosis occurred, which was followed by the identification of several mutations, including FII/prothrombin G20210A mutation high-risk heterozygous, FITGL, ITGB, PAI low-risk heterozygous, MTR homozygous, MTRR, MTHFR heterozygous mutations. Additionally, she has persistently tested positive for antiphospholipid antibodies (anti-β2-glycoprotein 1 IgAMG, anti-cardiolipin IgAMG). Anticoagulant agents were replaced by Warfarin and Hydroxychloroquine, the result was beneficial. After pregnancy diagnosis, the former was changed to LMWH. Plaquenil 200 mg daily administration during the entire pregnancy is recommended, except of bleeding episodes and hematoma
Results: The patient experienced recurrent venous thromboembolism while being treated with conventional anticoagulant therapy. The change of the treatment plan with Hydroxychloroquine inclusion was associated with the improvement of clinical presentation and imaging tests’ results.
Conclusions: Experience showed that Hydroxychloroquine administration allows to prevent recurrent thrombosis, safe pregnancy, prevents the risk of miscarriages.
To cite this abstract in AMA style:Movsisyan A, Karapetyan I, Harutyunyan A, Grigoryan H, Hambardzumyan L, Simonyan J, Sargsyan N, Tamamyan G, Danelyan S, Sahakyan L, Khachatryan H. The Role of Hydroxychloroquine in a Secondary Prevention of Recurrent Thrombosis in Patient with Thrombophilia and Antiphospholipid Syndrome. A Case Report [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/the-role-of-hydroxychloroquine-in-a-secondary-prevention-of-recurrent-thrombosis-in-patient-with-thrombophilia-and-antiphospholipid-syndrome-a-case-report/. Accessed August 16, 2022.
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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/the-role-of-hydroxychloroquine-in-a-secondary-prevention-of-recurrent-thrombosis-in-patient-with-thrombophilia-and-antiphospholipid-syndrome-a-case-report/