How to treat patients with thrombotic antiphospholipid syndrome in 2024?

Simona Caraiola, Massimo Radin, Ciprian Jurcut, Savino Sciascia

Journal: Polish archives of internal medicine 2024;134(11):

PMID: 39431716

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Abstract

Antiphospholipid syndrome (APS) encompasses a range of clinical conditions, particularly thrombotic or obstetrical manifestations, associated with the presence of antiphospholipid antibodies. Managing thrombotic APS in daily clinical practice can be challenging and requires thorough risk stratification and tailored treatment strategies. Primary prophylaxis focuses on correcting the traditional thrombotic risk factors and, in certain situations, may include low‑dose aspirin and / or prophylactic anticoagulants (eg, low‑molecular‑weight heparin). Treatment of thrombotic APS primarily involves long‑term anticoagulation with vitamin K antagonists (VKAs). In some cases, a combination of VKAs and low‑dose aspirin, increased doses of VKAs with an international normalized ratio target greater than 3, or a switch to therapeutic doses of low‑molecular‑weight heparin might be employed. The use of hydroxychloroquine is essential in patients with secondary systemic lupus erythematosus and may be considered in individuals with recurrent thrombosis. In other selected situations, the use of immunomodulatory agents can be considered.

Address: Department of Internal Medicine, Dr. Carol Davila Central University Emergency Military Hospital, Bucharest, Romania; Third Internal Medicine Department, Colentina Clinical Hospital, Bucharest, Romania; Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania; University Center of Excellence on Nephrological, Rheumatological and Rare Diseases (ERK-net, ERN-Reconnect and RITA-ERN Member) Including Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley (North-West Italy), San Giovanni Bosco Hub Hospital, ASL Città di Torino and Department of Clinical and Biological Sciences of the University of Turin, Turin, Italy; University Center of Excellence on Nephrological, Rheumatological and Rare Diseases (ERK-net, ERN-Reconnect and RITA-ERN Member) Including Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley (North-West Italy), San Giovanni Bosco Hub Hospital, ASL Città di Torino and Department of Clinical and Biological Sciences of the University of Turin, Turin, Italy. [email protected]

DOI: 10.20452/pamw.16863

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Full Text Sources:

https://pamw.pl/en/issue/article/39431716

Medical:

https://medlineplus.gov/bloodthinners.html

Miscellaneous:

https://assays.cancer.gov/CPTAC-1296

MeSH Terms: Antiphospholipid Syndrome, Humans, Thrombosis, Anticoagulants, Aspirin, Female, Hydroxychloroquine