Antiphospholipid Syndrome (APS) Treatment in India

Antiphospholipid Syndrome (APS) is a serious autoimmune condition that increases the risk of blood clots, strokes, miscarriages, and pregnancy complications due to abnormal antibodies affecting the blood vessels. India offers advanced and affordable care for APS through experienced rheumatologists and hematologists, with treatment protocols that include diagnostic testing, anticoagulation therapy, and support for pregnant women. The overall cost of managing APS in India typically ranges from $500 to $1,500 for stable cases and $4,000 to $7,000 for severe conditions, such as Catastrophic APS, which may require ICU care, plasmapheresis, and IVIG therapy. This makes India a cost-effective destination for high-quality APS care.

What is Antiphospholipid Syndrome (APS)?

Antiphospholipid Syndrome (APS) is an autoimmune disorder where the immune system mistakenly produces antibodies that target normal proteins in the blood, leading to an increased risk of blood clot formation. APS can cause various complications, affecting multiple organs and bodily systems.

Types of Antiphospholipid Syndrome (APS)

1. Primary APS

• Occurs in the absence of any underlying autoimmune disorder
• Most common form
• Patients present with:
  • Venous or arterial thrombosis
  • Pregnancy-related complications
• May remain isolated or evolve into secondary APS later

2. Secondary APS

• Occurs in association with other autoimmune diseases, especially:
  • Systemic Lupus Erythematosus (SLE)
  • Sjögren’s syndrome, rheumatoid arthritis, etc.
• Management often overlaps with the treatment of the underlying condition
• Patients tend to have a higher risk of recurrence and systemic involvement

3. Catastrophic APS (CAPS)

• Rare but life-threatening
• Characterized by:
  • Rapid-onset thrombosis in multiple organs
  • Usually triggered by infection, surgery, or medication withdrawal
• Requires ICU management with anticoagulation, high-dose steroids, IVIG, and plasmapheresis
• Mortality is high without prompt, aggressive treatment

4. Seronegative APS (SN-APS)

• Clinical features mimic APS, but:
  • Standard aPL tests (LA, aCL, β2GPI) are negative
• Diagnosis is controversial
• May involve non-standard aPL antibodies (e.g., anti-phosphatidylserine–prothrombin)
• Treated similarly if thrombotic or obstetric events are present

5. Asymptomatic aPL Carriers

• Individuals who test positive for aPL antibodies but have:
  • No history of thrombosis or pregnancy complications
• May be monitored closely, especially if:
  • Triple positive (LA, aCL, β2GPI)
• Other risk factors (smoking, hypertension, prolonged immobilization)

Diagnostic Criteria (Revised Sapporo Criteria)

Diagnosis requires:

• At least one clinical + one laboratory criterion

A. Clinical Criteria:

• One or more episodes of arterial, venous, or small vessel thrombosis
• Pregnancy complications:
  • ≥1 unexplained fetal death ≥10 weeks
  • ≥1 premature birth <34 weeks due to eclampsia or placental insufficiency
  • ≥3 unexplained consecutive miscarriages before 10 weeks

B. Laboratory Criteria:

• Positive test for LA, aCL (IgG or IgM), or anti-β2GPI on 2 occasions at least 12 weeks apart

Initial Treatment (Thrombotic APS)

A. Acute Thrombosis:

• Venous thrombosis: Heparin (LMWH or UFH) ➝ switch to warfarin with INR target 2.0–3.0
• Arterial thrombosis: May need higher INR (3.0–4.0) or combined antiplatelet (aspirin) + anticoagulation

B. Unprovoked or life-threatening thrombosis (Catastrophic APS - CAPS):

• ICU-level care with:
  • Anticoagulation
  • High-dose corticosteroids (e.g., methylprednisolone)
  • Plasmapheresis and/or IVIG
  • Treat underlying triggers (infections, surgery, etc.)

Long-term Management

• Vitamin K antagonists (Warfarin) are lifelong if thrombosis occurred
  • INR goal: 2.0–3.0 for venous
  • INR goal: 3.0–4.0 for arterial or recurrent thrombosis
• DOACs (e.g., rivaroxaban, apixaban): Not recommended for high-risk APS patients, especially triple-positive aPL
• Aspirin 75–100 mg/day:
  • For patients with no prior thrombosis but persistently positive aPL and other cardiovascular risk factors

APS in Pregnancy (Obstetric APS)

• Start low-dose aspirin (LDA): 75–100 mg/day preconception or upon diagnosis.
• Add prophylactic low-molecular-weight heparin (LMWH) upon confirmation of pregnancy.
• Continue both throughout pregnancy and postpartum (6 weeks)
• Monitor fetal growth and placental function

Catastrophic APS (CAPS) Protocol

A rare, life-threatening variant involving multiorgan thromboses. Immediate steps:

• IV heparin anticoagulation
• High-dose steroids
• IVIG or plasmapheresis
• Treat the underlying trigger (e.g., infection, surgery)

Antiphospholipid Syndrome (APS) Treatment Cost Comparison

The overall cost of treating antiphospholipid syndrome in India ranges from $500 to $1,500 for stable patients on anticoagulation and up to $4,000–$7,000 for severe cases, such as catastrophic APS, requiring ICU care, IVIG, and plasmapheresis.

Recovery Period for Antiphospholipid Syndrome (APS)

The concept of "recovery" in APS is different from curative conditions since APS is a chronic autoimmune disorder that requires long-term or lifelong management, especially after a thrombotic event.

1. After First Thrombotic Event (DVT, Stroke, etc.)

• Initial recovery: 2–6 weeks, depending on the type and severity of the clot
• Return to normal activity: Gradually over 4–8 weeks with anticoagulation
• Lifelong anticoagulation is typically required to prevent recurrence

2. Obstetric APS (After Pregnancy)

• Postpartum recovery: 6–8 weeks
• Anticoagulation may continue for 6 weeks postpartum
• Future pregnancies will require close monitoring and prophylaxis

3. Catastrophic APS (CAPS)

• Hospital stay: 2–4 weeks (including ICU care)
• Total recovery time: 2–3 months or longer
• Long-term rehabilitation may be needed for organ recovery (e.g., kidney, brain)

4. General Maintenance (Asymptomatic or Stable APS)

• No formal recovery phase, but:
  • Regular INR monitoring
  • Ongoing anticoagulation
  • Monitoring for complications