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Related Experiment Videos

New approaches for managing antiphospholipid syndrome.

Doruk Erkan1, Michael D Lockshin

  • 1The Barbara Volcker Center for Women and Rheumatic Disease, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA. erkand@hss.edu

Nature Clinical Practice. Rheumatology
|March 3, 2009
PubMed
Summary

Preventing thrombosis in antiphospholipid antibody (aPL)-positive individuals requires risk assessment and factor management. Current treatments like warfarin are standard for secondary prevention, but optimal anticoagulation and new therapies need more research.

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Area of Science:

  • Immunology
  • Hematology
  • Rheumatology

Background:

  • Antiphospholipid antibodies (aPL) target phospholipid-binding proteins, primarily beta(2)-glycoprotein-I.
  • Persistent aPL positivity necessitates a risk-stratified approach for thrombosis prevention.

Purpose of the Study:

  • To review current strategies and identify gaps in primary and secondary thrombosis prevention for aPL-positive individuals.
  • To explore emerging therapeutic targets for managing antiphospholipid syndrome (APS).

Main Methods:

  • Literature review of prospective, controlled studies on thrombosis prevention in aPL-positive patients.
  • Analysis of current recommendations and evidence for anticoagulation and adjunctive therapies in APS.
  • Examination of novel treatment modalities investigated in experimental APS models.

Main Results:

  • Evidence supporting aspirin for primary prevention in aPL-positive patients without vascular involvement is lacking.
  • Warfarin is recommended for secondary prevention, but optimal management and alternative anticoagulants require further investigation.
  • High-intensity anticoagulation efficacy in APS with vascular involvement is not well-established.
  • Catastrophic APS treatment yields high mortality despite aggressive multimodal therapy.
  • Emerging therapies like hydroxychloroquine, statins, rituximab, and complement inhibitors show promise in preclinical studies.

Conclusions:

  • A risk-stratified approach is essential for primary thrombosis prevention in aPL-positive individuals.
  • Further research is critical to define optimal anticoagulation strategies and evaluate novel therapies for APS.
  • Despite aggressive treatments, catastrophic APS remains associated with high mortality, highlighting the need for improved management.