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Antiphospholipid syndrome.

Doruk Erkan1, Michael D Lockshin

  • 1The Barbara Volcker Center for Women and Rheumatic Disease, Hospital for Special Surgery, and Weill Medical College of Cornell University, New York, USA. derkan@pol.net

Current Opinion in Rheumatology
|April 4, 2006
PubMed
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Management of antiphospholipid antibody (aPL)-positive patients requires careful consideration. Evidence supports warfarin for secondary thrombosis prevention, but primary prevention and treatment for catastrophic cases need further research.

Area of Science:

  • Rheumatology
  • Hematology
  • Immunology

Background:

  • Antiphospholipid antibodies (aPL) are associated with an increased risk of thrombosis and pregnancy complications.
  • Management strategies for aPL-positive patients are evolving, with a need for evidence-based guidelines.

Purpose of the Study:

  • To review recent studies guiding the management of persistently antiphospholipid antibody (aPL)-positive patients.
  • To synthesize current evidence on thrombosis prevention and treatment in aPL-associated conditions.

Main Methods:

  • Review of recently published prospective randomized controlled trials.
  • Analysis of experimental evidence from mouse models of antiphospholipid syndrome.
  • Synthesis of clinical data on management strategies for various aPL-related conditions.

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Main Results:

  • Moderate and high-intensity warfarin show similar efficacy for secondary thrombosis prevention in antiphospholipid syndrome (APS) after initial thrombosis.
  • Hydroxychloroquine and statins show potential therapeutic roles, though controlled studies are lacking.
  • Complement activation is crucial in aPL-mediated fetal loss, and heparin can prevent this via complement inhibition.

Conclusions:

  • Primary thrombosis prevention in aPL-positive individuals lacks evidence; risk factor modification and prophylaxis are key.
  • Secondary thrombosis prevention strategies, including warfarin's role, require further risk-stratification and debate.
  • Catastrophic APS management needs novel agents, while fetal loss is managed with aspirin and heparin, sometimes with added IVIg.
  • Anticoagulation is not proven effective for non-thrombotic manifestations of aPL.