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Update on antiphospholipid syndrome.

Michael D Lockshin1

  • 1Barbara Volcker Center for Women and Rheumatic Disease, Mary Kirkland Center for Lupus Research, Joan and Sanford Weill Medical College of Cornell University, Hospital for Special Surgery, USA.

Bulletin of the NYU Hospital for Joint Diseases
|November 24, 2006
PubMed
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The 2006 antiphospholipid syndrome criteria updated diagnostic timing and included new antibodies and clinical findings. Treatment for thrombosis remains warfarin, with ongoing investigation into treatment withdrawal.

Area of Science:

  • Rheumatology
  • Immunology
  • Hematology

Background:

  • The antiphospholipid syndrome (APS) is an autoimmune disorder associated with an increased risk of thrombosis and pregnancy morbidity.
  • Previous diagnostic criteria for APS were established in 1999.
  • Understanding of APS pathogenesis has evolved, implicating complement activation and innate immunity.

Purpose of the Study:

  • To summarize the revised diagnostic criteria for antiphospholipid syndrome published in 2006.
  • To highlight key changes from the previous 1999 criteria.
  • To discuss current understanding of APS pathogenesis and treatment.

Main Methods:

  • Review of the 2006 International Society on Thrombosis and Haemostasis APS diagnostic criteria.
  • Comparison of the 2006 criteria with the 1999 criteria.

Related Experiment Videos

  • Summary of updated information on APS pathogenesis and management.
  • Main Results:

    • Revised criteria increased the interval for laboratory confirmation from 6 to 12 weeks.
    • Antibody to beta2 glycoprotein I was accepted as a diagnostic criterion.
    • Associated findings like livedo reticularis, heart valve disease, and antibody to prothrombin were acknowledged; older age was excluded.
    • Pathogenesis concepts now include complement activation and innate immune system involvement.

    Conclusions:

    • The 2006 criteria refined APS diagnosis by adjusting laboratory requirements and incorporating new serological and clinical markers.
    • Current understanding emphasizes the role of complement and innate immunity in APS-related thrombosis.
    • Warfarin is the primary treatment for APS-related thrombosis, targeting an INR of 2.0-3.0, with potential for lifelong therapy; withdrawal strategies are under investigation.