Monitoring
There are no specific guidelines regarding long-term monitoring of patients with antiphospholipid syndrome (APS). Patients who are being treated with long-term anticoagulation should be monitored on a regular basis, depending on the form of anticoagulation used. Many patients taking vitamin K antagonists attend an anticoagulant clinic for international normalised ratio (INR) monitoring. Frequency of visits depends on their anticoagulant control. There is no indication for increased anticoagulant monitoring in the setting of APS but it is recognised it can often be difficult to achieve an acceptable time in therapeutic range for these patients. Some patients use self-monitoring devices, but some patients have antiphospholipid antibodies that interfere with the self-monitoring device INR, so each patient needs individual assessment for their suitability for this device.[88] For patients considering self INR monitoring devices who have positive lupus anticoagulant testing, it is recommended to confirm the accuracy of the self-monitoring device in comparison to at least three plasma INR results.[88] Patients may be followed up at regular intervals to monitor reduction of risk, use of anticoagulation, and surveillance for the development of other autoimmune disease, as well as to inform patients of new developments in diagnosis or treatment.
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