Controversies in the antiphospholipid syndrome: can we ever stop warfarin?

Fonseca, Ana Glória; D’Cruz, David

doi:10.1186/1740-2557-5-6

Cited by 20 publications

(21 citation statements)

References 68 publications

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“…The only proven treatment option is long-term anticoagulation with warfarin [143,144]. However, drugs used for other aspects of adult SLE may also modify this condition.…”

Section: Antiphospholipid Syndromementioning

confidence: 98%

Why are kids with lupus at an increased risk of cardiovascular disease?

2015

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Juvenile-onset systemic lupus erythematosus (SLE) is an aggressive multisystem autoimmune disease. Despite improvements in outcomes for adult patients, children with SLE continue to have a lower life expectancy than adults with SLE, with more aggressive disease, a higher incidence of lupus nephritis and there is an emerging awareness of their increased risk of cardiovascular disease (CVD). In this review, we discuss the evidence for an increased risk of CVD in SLE, its pathogenesis, and the clinical approach to its management.

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“…The only proven treatment option is long-term anticoagulation with warfarin [143,144]. However, drugs used for other aspects of adult SLE may also modify this condition.…”

Section: Antiphospholipid Syndromementioning

confidence: 98%

Why are kids with lupus at an increased risk of cardiovascular disease?

2015

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“…They are diverse for those with primary and secondary thromboembolic events, as well as for those with positive aPL antibodies but no known evidence of thromboses or pregnancy morbidity. Current recommendations for secondary thrombosis prevention in APS are for lifelong warfarin 4 …”

Section: Results Of Anti‐phospholipid Antibody Tests For the Three Pamentioning

confidence: 99%

“…Current recommendations for secondary thrombosis prevention in APS are for lifelong warfarin. 4 The following case reports highlight the difficulty in making a definite diagnosis of APS and the consequences of cessation of anticoagulation in known APS leading to CAPS, and hence further morbidity and mortality.…”

mentioning

confidence: 94%

Progression of antiphospholipid antibody syndrome to catastrophic antiphospholipid antibody syndrome acutely with cessation of antithrombotic therapy

Katikireddi

Kandiah

2012

Internal Medicine Journal

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Catastrophic antiphospholipid antibody syndrome (CAPS) is a serious condition that is often unrecognised with a high mortality. Cessation of anticoagulation in antiphospholipid antibody syndrome (APS) can have devastating consequences with progression to CAPS. Making a diagnosis of APS can however be challenging because of the evolving diagnostic criteria and difficulty in confirming thromboses. Management of these patients can also be complex, especially in those with coexistent thrombocytopenia. New potential treatments are emerging targeted on the immunomodulation of APS rather than just prevention of thrombosis. This article aims to highlight these diagnostic and management difficulties by reporting and discussing three cases of APS with progression to CAPS following cessation of anticoagulation, one with fatal consequences, with confirmation of CAPS on autopsy, and two with successful treatment and outcomes.

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“…The target INR advised in all recent reviews on secondary prophylaxis after a first VTE in APS patients [12][13][14][15][16] is at moderate intensity (target INR 2.5), which is similar to common practice in the general population. The basis for this recommendation for all reviews was the results of two prospective, randomized trials that compared high and moderate intensity anticoagulation in APS patients with a first VTE.…”

Section: Thrombotic Apsmentioning

confidence: 89%

Towards evidence-based treatment of thrombotic antiphospholipid syndrome

Derksen

Groot

2010

Lupus

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Thrombosis in the presence of persistently positive tests for antiphospholipid antibodies is termed thrombotic antiphospholipid syndrome (APS). At present, 'standard' secondary thromboprophylaxis in thrombotic APS is treatment with moderate intensity oral anticoagulants for life after a first venous thrombosis and with high intensity oral anticoagulation after non-embolic ischaemic stroke. These recommendations differ from those applied in the general population, where a restricted period of anticoagulation is common practice after venous thrombosis and antiplatelet drugs are the first choice after ischaemic stroke. From an extensive literature review we conclude that the available data are insufficient to apply a different strategy for secondary thromboprophylaxis in patients with thrombotic APS than the one that holds for the general population.

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Controversies in the antiphospholipid syndrome: can we ever stop warfarin?

Cited by 20 publications

References 68 publications

Why are kids with lupus at an increased risk of cardiovascular disease?

Why are kids with lupus at an increased risk of cardiovascular disease?

Progression of antiphospholipid antibody syndrome to catastrophic antiphospholipid antibody syndrome acutely with cessation of antithrombotic therapy

Towards evidence-based treatment of thrombotic antiphospholipid syndrome

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