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Related Experiment Video

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Procoagulant Platelet Characterization by Measuring Phosphatidylserine Exposure and Microvesicle Release from Human Purified Platelets
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Evolution of Antiphospholipid Syndrome.

Deepa R J Arachchillage1,2, Charis Pericleous3

  • 1Department of Immunology and Inflammation, Centre for Haematology, Imperial College London, London, United Kingdom.

Seminars in Thrombosis and Hemostasis
|January 16, 2023
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Summary

Antiphospholipid syndrome (APS) is an autoimmune disorder causing blood clots and pregnancy issues due to antiphospholipid antibodies (aPL). Current treatments focus on anticoagulation for thrombotic APS and heparin with aspirin for obstetric APS, with immunomodulators used for refractory cases.

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Area of Science:

  • Autoimmune Diseases
  • Hematology
  • Obstetrics & Gynecology

Background:

  • Antiphospholipid syndrome (APS) is an autoimmune disease defined by the presence of antiphospholipid antibodies (aPL) leading to thrombosis and/or pregnancy complications.
  • Historical context traces APS back to mid-20th century syphilis screening observations and early links to recurrent miscarriages over 40 years ago.
  • Understanding of APS pathogenesis and management has significantly advanced since its initial identification.

Purpose of the Study:

  • To review the evolution of understanding in antiphospholipid syndrome (APS) pathogenesis.
  • To outline current treatment strategies for thrombotic and obstetric APS.
  • To discuss emerging therapeutic options for refractory APS cases.

Main Methods:

  • Review of historical observations and scientific literature on antiphospholipid syndrome (APS).
  • Analysis of established treatment protocols for thrombotic and obstetric manifestations of APS.
  • Evaluation of the role and efficacy of immunomodulatory agents in APS management.

Main Results:

  • Anticoagulation with vitamin K antagonists (VKAs) is the primary treatment for thrombotic APS, outperforming direct oral anticoagulants, particularly in triple-positive APS and arterial thrombosis.
  • Low-molecular-weight heparin and low-dose aspirin are the standard treatments for obstetric complications in APS.
  • Inflammation, complement activation, and placental thrombosis are implicated in the pathogenesis of obstetric APS.

Conclusions:

  • Current management of APS prioritizes anticoagulation for thrombotic events and heparin/aspirin for obstetric complications.
  • Immunomodulatory agents like hydroxychloroquine are increasingly utilized for APS patients resistant to standard therapies.
  • Continued research into APS pathogenesis may lead to novel therapeutic strategies.