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Management of Antiphospholipid Syndrome in Patients with Systemic Lupus Erythematosus

  • Lupus (S Keeling, Section Editor)
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Current Treatment Options in Rheumatology Aims and scope Submit manuscript

Abstract

Purpose of review

To provide an approach to primary and secondary prevention of thrombotic events and obstetric complications in patients with antiphospholipid antibodies (aPL) with or without antiphospholipid syndrome (APS), particularly in association with systemic lupus erythematosus (SLE).

Recent findings

The available evidence would suggest that direct oral anticoagulants are inferior to warfarin at prevention of recurrent thrombosis, particularly in patients with a history of arterial thrombosis or triple aPL positivity. Novel therapies currently being considered for APS include eculizumab, and B cell inhibitors, which may have a role in refractory or resistant APS.

Summary

Patients should be risk-stratified for risk of thromboembolism, and traditional cardiovascular risk factors addressed. Primary prophylaxis with aspirin should be considered in patients with SLE and aPL. Secondary prevention for APS is with warfarin with an INR of 2.0–3.0. Pregnant SLE patients with aPL/APS are managed with aspirin and heparin.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada

    Mary-Clair Yelovich MD, BSc, BA, MA, FRCPC & Kimberly J. Legault MD, MSc, FRCPC

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  1. Mary-Clair Yelovich MD, BSc, BA, MA, FRCPC
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  2. Kimberly J. Legault MD, MSc, FRCPC
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Correspondence to Kimberly J. Legault MD, MSc, FRCPC.

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Mary-Clair declares that she has no conflict of interest. Kimberly was an investigator on a study that received in-kind research support from Bayer.

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Yelovich, MC., Legault, K.J. Management of Antiphospholipid Syndrome in Patients with Systemic Lupus Erythematosus. Curr Treat Options in Rheum 5, 190–200 (2019). https://doi.org/10.1007/s40674-019-00126-w

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