Anticoagulant Therapy in Patients with Antiphospholipid Syndrome

Abstract

Antiphospholipid syndrome (APS) is a systemic autoimmune disease characterized by the persistent positivity of antiphospholipid antibodies (aPLA) together with thrombosis or obstetrical complications. Despite their recognized predominant role, aPLA are not sufficient to induce the development of thrombosis and a second hit has been proposed to be necessary. The mainstay of treatment of APS is anticoagulant therapy. However, its optimal intensity in different presentations of the disease remains undefined. Moreover, decision on which patients with aPLA would benefit from an antithrombotic prophylaxis and its optimal intensity are challenging because of the lack of stratification tools for the risk of thrombosis. Finally, decision on the optimal type of anticoagulant drug is also complex because the central pathway responsible for the development of thrombosis is so far unknown and should be carried out on an individual basis after a careful evaluation of the clinical and laboratory features of the patient. This review addresses the epidemiology, physiopathology, diagnosis and management of thrombosis and obstetrical complications in APS, with a special focus on the role of direct oral anticoagulants.

Antiphospholipid syndrome in cardiovascular disease and cancer

“…Short term (3-6 months) anticoagulation may be suitable for patients with aPL who develop thrombosis in the setting of a reversible risk factor, or those who subsequently test negative for aPL. 70 The use of VKAs may be affected by food and drug interactions, thus, many patients may need frequent monitoring. In this way the direct oral anticoagulants (DOACs) may be an alternative, but still, there are variable results from various case studies.…”

“…Regarding the duration of anticoagulation, it is strongly recommended that all cases should be considered on an individual basis and based on the patient‐specific risk–benefit ratio. Short term (3–6 months) anticoagulation may be suitable for patients with aPL who develop thrombosis in the setting of a reversible risk factor, or those who subsequently test negative for aPL 70 . The use of VKAs may be affected by food and drug interactions, thus, many patients may need frequent monitoring.…”

To Clot or Not to Clot: Is That the Question?

“…Another example of a pro-coagulant disease is antiphospholipid antibody syndrome (APS), which arises due to the formation of antiphospholipid antibodies (aPL). These antibodies can arise against a variety of phospholipid moieties [ 5 ]. Perhaps unsurprisingly, given the above context, patients with APS, reflecting an autoimmune disorder, are also given anticoagulant therapy to help treat and prevent thrombosis.…”

“…Perhaps unsurprisingly, given the above context, patients with APS, reflecting an autoimmune disorder, are also given anticoagulant therapy to help treat and prevent thrombosis. Again, the use of both aspirin and heparin may play a role in these patients [ 5 , 6 ], but also recognizing that prevention of thrombosis may come with the risk of bleeding. For the long-term prevention of venous thrombosis, APS patients are often placed on vitamin K antagonist (VKA) therapy, such as warfarin.…”

Non-pharmacological rehabilitation interventions for individuals with antiphospholipid syndrome: A scoping review

“…14,17 Although taking life-long anticoagulant medication, the primary treatment for APS, effectively reduces the risk of major thrombotic events such as deep-vein thrombosis and stroke, it does not address other reported issues by patients with APS. [18][19][20][21] In fact, some individuals with APS who are on anticoagulants have reported lower quality of life compared to those not taking anticoagulants. Though no follow-up interviews have been conducted to further understand this finding (e.g., is the worse quality of life due to treatment burden?…”