Management of Anticoagulation in Antiphospholipid Syndrome and Systemic Lupus Erythematosus With Concurrent Thrombosis and Hemorrhage.

Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by arterial, venous, or small-vessel thromboembolic events and/or pregnancy morbidity in the presence of antiphospholipid antibodies. APS can occur in the setting of an underlying systemic autoimmune disease, particularly systemic lupus erythematosus (SLE). SLE is a chronic autoimmune disease that can affect virtually any organ of the body due to the production of antinuclear antibodies. During the course of their disease, many patients develop pulmonary manifestations, including alveolar hemorrhage. We describe a clinical case of a 35-year-old woman with APS and SLE, anticoagulated with warfarin, who went to the emergency room with asthenia and productive cough with hemoptysis, and was diagnosed with a lupus flare and pulmonary-renal syndrome. Anticoagulation had to be discontinued due to the high risk of recurrent bleeding (HAS-BLED score 3). This case report describes the difficulty in managing the anticoagulant therapy in a patient with APS and SLE with both thrombotic and hemorrhagic manifestations.