REVIEW - Management of antiphospholipid syndrome

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J Autoimmun. 2009 Jun 24.

Management of antiphospholipid syndrome.

Tuthill JI, Khamashta MA.

The Louise Coote Lupus Unit, St ' Hospital, Westminster Bridge

Road, London, SE1 7EH, UK.

Antiphospholipid syndrome (APS) is characterised by vascular

thrombosis and/or obstetric morbidity in the presence of persistently

positive antiphospholipid antibodies (aPL). Balancing an individuals'

risk of thrombosis against the benefits and risks of antithrombotic

therapies is crucial for optimising management and preventing

morbidity in APS and asymptomatic aPL. Limitations in research studies

have led to debate regarding best-practice. This review of the

available literature makes the following recommendations. Those with

asymptomatic aPL should only be treated with aspirin if they have

persistently positive aPL, obstetric APS, or co-existent systemic

lupus erythematosus. For those with APS, lower risk patients (i.e.

first venous thrombosis) should be treated with warfarin to an INR

2.0-3.0. Those at higher risk (i.e. arterial thrombosis or recurrent

events) should be treated with warfarin to an INR of >3.0. During

pregnancy in APS, low molecular weight heparin (LMWH) and aspirin

should be used and women should be under the care of obstetricians and

physicians specialising in APS. Additional vascular and thrombotic

risk factors should be actively reduced in all patient groups. Further

randomised controlled trials are required, which should involve larger

patient groups with APS diagnosed according to accepted criteria. This

may mean that international and multi-centre trials are needed to

ascertain the best treatment regimens.

PMID: 19559568

http://www.ncbi.nlm.nih.gov/pubmed/19559568

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