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Antiphospholipid antibodies in critical illness
Francesco Dentali1, Mark Crowther
1St. Joseph's Hospital, Hamilton, Ontario, Canada.
Critical Care Medicine
|January 20, 2010
Summary
Antiphospholipid syndrome treatment focuses on antithrombotic therapies to prevent recurrent clots. Moderate-intensity warfarin effectively prevents venous thrombosis recurrence, while aspirin and warfarin show similar efficacy for preventing recurrent stroke.
Area of Science:
- Hematology
- Immunology
- Vascular Medicine
Background:
- Antiphospholipid syndrome (APS) is characterized by antiphospholipid antibodies and recurrent thromboembolism or pregnancy morbidity.
- Antithrombotic therapies are crucial for managing APS to mitigate the risk of recurrent thrombotic events.
- While the risk of new thrombosis is low in healthy individuals with APS, it is significantly elevated in those with a history of arterial or venous thrombosis.
Purpose of the Study:
- To evaluate the efficacy of antithrombotic therapies in preventing recurrent thromboembolic events in patients with antiphospholipid syndrome.
- To compare the effectiveness of warfarin and aspirin in preventing recurrent stroke in specific APS patient subgroups.
- To explore optimal treatment strategies for the catastrophic variant of APS and other clinical manifestations.
Main Methods:
- Review of existing literature on antithrombotic treatments for antiphospholipid syndrome.
- Analysis of studies comparing warfarin (INR 2.0-3.0) with placebo or no treatment for recurrent thrombotic events.
- Comparison of aspirin and moderate-intensity warfarin for stroke prevention in APS patients with prior stroke.
Main Results:
- Moderate-intensity warfarin (INR 2.0-3.0) likely reduces the recurrence of thrombotic events compared to placebo or no treatment.
- Aspirin and moderate-intensity warfarin demonstrate comparable efficacy in preventing recurrent stroke in patients with a history of stroke and a single positive antiphospholipid antibody test.
- First-line treatment including anticoagulation, corticosteroids, plasma exchange, and IVIG appears effective in reducing mortality and catastrophic thrombotic events in catastrophic APS.
Conclusions:
- Moderate-intensity warfarin is an effective treatment for preventing recurrent venous thrombotic events in APS.
- Aspirin is as effective as moderate-intensity warfarin for preventing recurrent stroke in specific APS patient populations.
- Further prospective studies are needed to determine optimal treatments for other APS clinical manifestations.
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