Diagnosing and treating antiphospholipid syndrome: a consensus paper.

Area of Science:

• Rheumatology and Immunology
• Hematology
• Obstetrics and Gynecology

Background:

• Antiphospholipid syndrome (APS) is characterized by thrombosis and/or pregnancy morbidity with antiphospholipid antibodies (aPL).
• Large-scale clinical trials for APS management are scarce, necessitating expert consensus.
• This paper addresses the need for evidence-based clinical practice guidelines in APS care.

Framework:

• Expert consensus developed through literature review, consensus meetings, and Delphi procedures.
• Diagnostic criteria for APS combine thrombotic events with confirmed aPL presence.
• Risk stratification for recurrent thrombosis, particularly in 'triple positive' patients, remains a clinical challenge.

Implementation:

• First-line treatment for venous thrombosis in APS involves Vitamin K antagonists (VKA) targeting INR 2.0-3.0.
• For arterial thrombosis, clopidogrel or VKA (INR 2.0-3.0) are recommended; direct oral anticoagulants are not advised.
• Patients with catastrophic APS, recurrent events, or pregnancy morbidity require referral to specialized centers.

Implications:

• This consensus provides practical guidance bridging evidence-based medicine and daily clinical management of APS.
• Standardized diagnostic and treatment approaches can improve outcomes for APS patients.
• Highlights the importance of expert centers for complex APS cases and recurrent morbidity.