Antiphospholipid syndrome: laboratory detection, mechanisms of action and treatment

Abstract

Abstract. Tripodi A, de Groot PG, Pengo V (IRCCS Cà Granda Ospedale Maggiore Policlinico Foundation and Università degli Studi di Milano, Milan, Italy; Utrecht University Medical Center, Utrecht, the Netherlands; Thrombosis Center, University Hospital, Padua, Italy). Antiphospholipid syndrome: laboratory detection, mechanisms of action and treatment (Review). J Intern Med 2011; 270: 110-122.The antiphospholipid syndrome (APS) identifies a condition at increased risk of vascular occlusion and ⁄ or pregnancy complications. Patients are defined as having APS if they have at least one clinical (vascular occlusion and ⁄ or pregnancy complications) and one laboratory criterion at the same time. The laboratory criteria that define APS are repeated positivity (confirmed 12 weeks apart) for lupus anticoagulants and ⁄ or antibodies targeted against cardiolipin or b 2 -glycoprotein I immobilized on solid surfaces. Over the years, APS has attracted the interest of many medical specialties. The aim of this review is to provide an update on (i) the laboratory criteria that determine the presence of APS, (ii) how the antibodies increase the risk of vascular occlusion and foetal loss and (iii) the treatment of the related clinical events.

Thrombotic recurrences and bleeding events in APS vascular patients: A review from the literature and a comparison with the APS Piedmont Cohort

“…The study was performed according to the principles of the Declaration of Helsinki and informed consent was signed by each patient at diagnosis, when they entered in the Interregional Registry of Rare Diseases -National Health Service. All thrombotic events were objectively documented and patients were treated according to current recommendations at the time of diagnosis [13], [14], [15], [16] and [17].…”

Accidente cerebrovascular embólico por endocarditis de Libman-Sacks como manifestación inicial de síndrome antifosfolípidos primario en una paciente de 17 años: Report of one case

“…Actualmente, hay cierto consenso en la indicación de tratamiento anticoagulante con antagonistas de vitamina K (AVK) para pacientes con SAF clínico, con manifestaciones trombóticas arteriales o venosas por tiempo indefinido [12][13][14] . La decisión de mantener el tratamiento indefinidamente se debe juzgar caso a caso, poniendo en la balanza el riesgo de recurrencia trombótica versus el riesgo de presentar hemorragias mayores con la anticoagulación.…”

“…La decisión de mantener el tratamiento indefinidamente se debe juzgar caso a caso, poniendo en la balanza el riesgo de recurrencia trombótica versus el riesgo de presentar hemorragias mayores con la anticoagulación. Según plantea una revisión reciente del tema, los pacientes que han presentado trombosis arterial debieran tratarse además con ácido acetil salicílico 100 mg al día 12 , pero no se encontraron ensayos clínicos de distribución aleatoria (ECR) que avalen tal recomendación 14 .…”

“…En revisiones más actuales se ha empezado a mencionar el rol de los nuevos anticoagulantes para los pacientes con SAF, pero hasta el momento no se dispone de estudios al respecto 12,13 . El uso de hidroxicloroquina estaría recomendado en casos de SAF refractario y en los asociados a LES, sin embargo, pareciera prometedor su uso también en SAF primario dado sus propiedades anticoagulantes, pero no existen ECR que avalen su uso en este escenario 18 .…”

Anti-cardiolipin and anti-β2-glycoprotein I antibodies: normal reference ranges in northwestern Italy

“…1 An accurate laboratory diagnosis of aPL is critical since thrombosis and pregnancy morbidity have a high incidence in the general population and a multifactorial aetiology. 2 All laboratory tests used to detect aPL show poor standardization although efforts have been made especially for LA thanks to the updated guidelines.…”