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Treatment of the antiphospholipid antibody syndrome

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Abstract

Numerous questions exist regarding the proper management of patients with the antiphospholipid antibody syndrome (APS). Several recent, randomized-controlled trials have been conducted that attempt to answer the fundamental questions of whom to treat, how to treat, and for how long treatment should last. These studies suggest that APS should be categorized by disease manifestations, and these presentations may have different treatment algorithms. A better understanding of the immune mechanisms that govern thrombosis in this syndrome has led to a wide array of innovative treatment approaches that will require meticulous study.

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References and Recommended Reading

  1. Wilson W, Gharavi A, Koike T, et al.: International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome. Arthritis Rheum 1999, 42:1309–1311.

    Article  PubMed  CAS  Google Scholar 

  2. Khamashta M, Shoenfeld Y: Antiphospholipid syndrome: a consensus for treatment? Lupus 2003, 12:495.

    Article  PubMed  Google Scholar 

  3. Baker R: Prevention and recurrent thrombosis in the APS syndrome: how long and how high with oral anticoagulant therapy? MJA 2003, 180:436–437.

    Google Scholar 

  4. Rosove MH, Brewere PM: Antiphospholipid thrombosis: clinical course after the first thrombotic event in 70 patients. Ann Intern Med 1992, 117:303–308.

    PubMed  CAS  Google Scholar 

  5. Drenkard C, Villa A, Alarcon-Sebovia D, Perez-Vazquez M: Influence of the antiphospholipid syndrome in the survival of patients with systemic lupus erythematosus. J Rheumatol 1994, 21:1067–1072.

    PubMed  CAS  Google Scholar 

  6. Khamasta M, Cuadrado M, Mujic F, et al.: The management of thrombosis in the antiphospholipid-antibody syndrome. N Engl J Med 1995, 332:993–997.

    Article  Google Scholar 

  7. Pattison N, Chamley L, Birdsall M, et al.: Does aspirin have a role in improving outcome for women with antiphospholipid syndrome? A randomized controlled trial. Am J Obstet Gynecol 2000, 183:1008–1012.

    Article  PubMed  CAS  Google Scholar 

  8. Kutteh W: Antiphospholipid antibody-associated recurrent pregnamcy loss: treatment with heparin and low-dose aspirin is superior to low-dose aspirin alone. Am J Obstet Gynecol 1996, 174:1584–1589.

    Article  PubMed  CAS  Google Scholar 

  9. Amigo M: Antiphospholipid (Hughes) Syndrome: prognosis. Rheum Dis Clin North Am 2001, 27:661–669.

    Article  PubMed  CAS  Google Scholar 

  10. Branch D, Khamashta A: Antiphospholipid syndrome: obstetric diagnosis, management, and controversies. Obstet Gynecol 2003, 101:1333–1344. An expert’s view on the therapeutic approach to obstetric APS. The authors discuss the confusion that has resulted from discrepancies in the patient groups included into various obstetric APS trials.

    Article  PubMed  Google Scholar 

  11. Crowther M, Ginsberg J, Julian J, et al.: A comparison of two intensities of warfarin for the prevention of recurrent thrombosis in patients with APS syndrome. N Engl J Med 2003, 349:1133–1138. This is the first randomized, controlled trial comparing the efficacy and safety of high-intensity (INR 3.1–4.0) versus moderate-intensity (INR 2.0–3.0) warfarin therapy in patients with APS. No significant difference in recurrent thrombosis was detected between the two groups.

    Article  PubMed  CAS  Google Scholar 

  12. Lockshin MD, Erkan D: Treatment of the antiphospholipid syndrome. N Engl J Med 2003, 349:1177–1179.

    Article  PubMed  CAS  Google Scholar 

  13. Petri M: Evidence-based management of thrombosis in the antiphospholipid antibody syndrome. Curr Rheumatol Reports 2003, 5:370–373.

    Article  Google Scholar 

  14. Schulman S, Svenungsson B, Granqvist S: Anticardiolipin antibodies predict early recurrence of thromboembolism and death among patients with venous thromboembolism following anticoagulant therapy. Duration of Anticoagulation Study Group. Am J Med 1998, 104:332–338.

    Article  PubMed  CAS  Google Scholar 

  15. Rai R, Cohen H, Dave M, Regan L: Randomized controlled trial of aspirin and aspirin plus heparin in pregnant women with recurrent miscarriage associated with phospholipid antibodies (or antiphospholipid antibodies). BMJ 1997, 314:253.

    PubMed  CAS  Google Scholar 

  16. Farquharson RG, Quenby S, Greaves M: Antiphospholipid syndrome in pregnancy: a randomized, controlled trial of treatment. Obstet Gynecol 2002, 100:408–413.

    Article  PubMed  CAS  Google Scholar 

  17. Triolo G, Ferrante A, Ciccia F, et al.: Randomized study of subcutaneous low molecular weight heparin plus aspirin versus intravenous immunoglobulin in the treatment of recurrent fetal loss associated with antiphospholipid antibodies. Arthritis Rheum 2003, 48:728–731.

    Article  PubMed  CAS  Google Scholar 

  18. Tincani A, Branch W, Levy RA, et al.: Treatment of pregnant patients with antiphospholipid syndrome. Lupus 2003, 12:524–529.

    Article  PubMed  CAS  Google Scholar 

  19. Derksen RHWM, Khamashta MA, Branch DW: Management of the obstetric antiphospholipid syndrome. Arthritis Rheum 2004, 50:1028–1039. A well written review article summarizing data from various clinical trials. Includes clear treatment tables and figures for different clinical scenarios.

    Article  PubMed  CAS  Google Scholar 

  20. Ginsberg JS, Greer J, Hirsh J: Use of antithrombotic agents during pregnancy. Chest 2001, 119(Suppl 1):122S-131S.

    Article  PubMed  CAS  Google Scholar 

  21. Sanson BJ, Lensing AW, Prins MH, et al.: Safety of low-molecular weight heparin in pregnancy: a systemic review. Thromb Haemost 1999, 81:668–672.

    PubMed  CAS  Google Scholar 

  22. Levine SR, Brey RL, Tilley BC, et al.: Antiphospholipid antibodies and subsequent thrombo-occlusive events in patients with ischemic stroke. JAMA 2004, 291:576–584. A prospective cohort study within the Warfarin versus Aspirin Recurrent Stroke Study (WARSS), looking at 720 aPL-positive patients and 1050 aPL-negative patients. The presence of aPL among patients with ischemic stroke did not predict increased risk for subsequent vascular occlusive events over 2 years or a differential response to aspirin or warfarin therapy.

    Article  PubMed  CAS  Google Scholar 

  23. Asheron R, Cervera R, de Groot P, et al.: Catastrohpic antiphospholipid syndrome: international consensus statement on classification criteria and treatment guidelines. Lupus 2003, 12:530–534.

    Article  Google Scholar 

  24. Asheron R, Cerva R, Piette J, et al.: Catastrophic antiphospholipid syndrome: clinical and laboratory features of 50 patients. Medicine (Baltimore) 1998, 77:195–207.

    Article  Google Scholar 

  25. Asheron R, Cerva R, Piette J, et al.: Catastrophic antiphospholipid syndrome: clues to the pathogenesis from a series of 80 patients. Medicine (Baltimore) 2001, 80:355–377.

    Article  Google Scholar 

  26. Erkan D, Cervera R, Asheron R: Catastrophic antiphospholipid syndrome: where do we stand? Arthritis Rheum 2003, 48:3320–3327. An outstanding review on the diagnosis and treatment of CAPS. Provided in the article is a treatment guideline proposed and accepted during the 10th International Congress on antiphospholipid Antibodies in Taormina, Sicily, September 2002.

    Article  PubMed  Google Scholar 

  27. Lockshin M, Tenedios F, Petri M, et al.: Cardiac disease in the antiphospholipid syndrome: recommendations for treatment. Committee consensus report. Lupus 2003, 12:518–512.

    Article  PubMed  CAS  Google Scholar 

  28. Alarcon-Segovia D, Boffa M, Branch W, et al.: Prophylaxis of the antiphospholipid syndrome: a consensus report. Lupus 2003, 12:499–503.

    Article  PubMed  CAS  Google Scholar 

  29. Erkan D, Yazici Y, Peterson G, et al.: A cross-sectional study of clinical thrombotic risk factors and preventive treatments in antiphospholipid syndrome. Rheumatology 2002, 41:924–929.

    Article  PubMed  CAS  Google Scholar 

  30. Giron-Gonzalez J, Del Rio E, Rodriguez C, et al.: Antiphospholipid syndrome and asymptomatic carriers of antiphospholipid antibody: prospective analysis of 404 individuals. J Rheumatol 2004, 31:1560–1567. A prospective study that examined the outcomes in patients with APS and in asymptomatic antiphospholipid antibody carriers (AAPC). During the follow-up period of 36 months, no episode of thrombosis was detected in any asymptomatic carrier.

    PubMed  Google Scholar 

  31. Wahl D, Bounameaux H, Moerloose P, Sarasin F: Prophylactic antithrombotic therapy for patients with systemic lupus erythematosus with or without antiphospholipid antibodies. Arch Intern Med 2000, 160:2042–2048.

    Article  PubMed  CAS  Google Scholar 

  32. Merrill J: LJP 1082: a toelragen for Hughes syndrome. Lupus 2004, 13:335–338.

    Article  PubMed  CAS  Google Scholar 

  33. Roubey R: New approaches to prevention of thrombosis in the antiphospholipid syndrome: hopes, trials, and tribulations. Arthritis Rheum 2003, 48:3004–3008.

    Article  PubMed  CAS  Google Scholar 

  34. Ferrara D, Lie X, Espinola R, et al.: Inhibition of the thrombogenic and inflammatory properties of antiphospholipid antibodies by fluvastatin in an in vivo animal model. Arthritis Rheum 2003, 48:3272–3279. Using an in vivo mouse model, this study showed that IgG-APS mice treated with fluvastatin showed significantly smaller thrombi, a reduced number of adherent leukocytes, and decreased levels of sICAM-1 compared with IgG-APS mice treated with placebo.

    Article  PubMed  CAS  Google Scholar 

  35. Blank M, Krause I, Wildbaum G, et al.: TNFα DNA vaccination prevents clinical manifestations of experimental antiphospholipid syndrome. Lupus 2003, 12:546–549.

    Article  PubMed  CAS  Google Scholar 

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Wu, C., Kalunian, K. Treatment of the antiphospholipid antibody syndrome. Curr Rheumatol Rep 6, 463–468 (2004). https://doi.org/10.1007/s11926-004-0026-z

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  • DOI: https://doi.org/10.1007/s11926-004-0026-z

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