Unexplained venous thromboses is treated by starting the pt. On short chain heparins followed by aspirin as the first line treatment and clopidogrel if there is contraindication to the former. You may not be able to document the stickey  platelet syndrome despite utilising the available testing facilities.

Arterial thrombosis management needs a different strategy i.e either surgical thrombectomy or thrombolysis using urokinase,tPA etc followed by oral anticoagulants ( Warfarin/coumarins/ Dabigartran) for definitive  long term management .

In my practice in Thailand, I have never sent the test for SPS. But in general I use ASA for arterial and LMWH for venous events. I am not sure if this syndrome was mentioned in the latest guideline, yet.

SPS is not rare finding if the platelets are incriminated in thrombosis. Aspirin works only as a prophylaxis not as curative

Dear Mohammed, what is your strategy if patient does not respond to warfarin? And were those  unexplained VTEs tested for thrombophilia?

Mohsen, for the treatment of SPS, we use algorithm published in SeminThromb Hemost 2013;39:674-683.

Peter

Dear Peter Kubisz, we do evaluate the patients for thrombophilia which also includes ruling out other causes of thromboses( factor 5 maiden, thrombomodulin gene mutation, Anticardiolipin ab, factor deficiencies etc)We do follow the protocol usually. 

However , in arterial thromboses ( after opening of the artery either surgically or thrombolysis) we use continuous infusion of heparin initially, followed by oral anticoagulants. If a patient does not respond to warfarin I shift to dabigatran / or other recent congeners. If I am not able to find the cause for arterial thromboses ,the patient has to be on life long anticoagulants and only on anti platelets for venous thromboses. However if there is recurrence of thromboses on anti platelets in the latter , we shift the pt to  oral anticoagulatants.