Management of antiphospholipid syndrome

La Revue de médecine interne
D SaadounN Costedoat-Chalumeau

Abstract

The prevention of thrombosis in the antiphospholipid syndrome (APS) remains controversial. The purpose of this review is to provide updated recommendations. There is evidence that patients at risk of thrombosis are those with "a pattern of high risk antiphospholipid antibodies (aPL)" (presence of a lupus anticoagulant [LA], association of several aPL, or persistent aCL at a medium or high level), or those with associated systemic lupus erythematosus (SLE). The prescription of aspirin in primary prevention is recommended in SLE patients with positive LA or persistent aCL at a significant level. Secondary prevention is based on a very prolonged anticoagulation. An INR around 2.5 seems to be sufficient in patients with venous APS. In case of arterial events, the attitude is debated. We propose to maintain a target INR between 3 and 3.5. The possible occurrence of relapse despite anticoagulation in the therapeutic target may lead to the addition of aspirin. The development of new anti-thrombotic agents might change the management of APS in the coming years.

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Citations

Oct 2, 2013·La Revue de médecine interne·T BarbaA Mahr
Oct 12, 2013·Néphrologie & thérapeutique·Manon DekeyserDenis Wahl
Jan 28, 2014·Acta neurologica Belgica·Ch De MaeseneireM Gille
Jan 3, 2015·Joint, Bone, Spine : Revue Du Rhumatisme·Adrien MichonJean-Benoît Arlet

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Antiphospholipid Syndrome

Antiphospholipid syndrome or antiphospholipid antibody syndrome (APS or APLS), is an autoimmune, hypercoagulable state caused by the presence of antibodies directed against phospholipids.

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