Evolution of Antiphospholipid Syndrome

Abstract

Antiphospholipid syndrome (APS) is an autoimmune prothrombotic disease characterized by thrombosis and/or pregnancy complications caused by antiphospholipid antibodies (aPL). The history of APS can be traced back to observations made during screening programs for syphilis conducted in the mid-20th century, with identification of patients with the so-called biological false-positive serological reactions for syphilis. Initial observation linking aPL with recurrent miscarriages was first reported more than 40 years ago. Since then, our understanding of the pathogenesis and management of APS has evolved markedly. Although APS is an autoimmune disease, anticoagulation mainly with vitamin K antagonists (VKAs) rather than immunomodulation, is the treatment of choice for thrombotic APS. Direct acting oral anticoagulants are inferior to VKAs, especially those with triple-positive APS and arterial thrombosis. Inflammation, complement activation, and thrombosis in the placenta may contribute to pathogenesis of obstetric APS. Heparin, mainly low-molecular-weight heparin, and low-dose aspirin represent the treatments of choice for women with obstetric complications. Increasingly, immunomodulatory agents such as hydroxychloroquine for thrombotic and obstetric APS are being used, especially in patients who are refractory to present standard treatment.

Why Does Rivaroxaban Not Work in Severe Mitral Stenosis?

“…Perhaps an administration twice a day employing 15 mg every 12 hours might have been more appropriate for counterbalancing the thrombotic milieu of patients with mitral stenosis and atrial fibrillation, since the half-life of rivaroxaban is around 12 hours. 32 Another condition in which rivaroxaban resulted inferior to warfarin is the antiphospholipid syndrome, 33 probably because of similar pathophysiological reasons: an important prothrombotic burden driven by both cellular and complement activation 34 on one hand and the single dosage of rivaroxaban on the other, as stated earlier. A new potential strategy may be provision of dual DOACs (anti-Xa, anti-IIa), because of synergy between lower dosages of each, as has been recently demonstrated in vitro.…”

2024 Eberhard F. Mammen Award Announcements: Part I—Most Popular Articles

“…Consequently, the most popular papers from each category are identified separately. Tables 3 and 4 respectively list the top 25 downloaded articles from STH in 2023 (from 2022 and 2023 inclusive), as eligible for either the “free access” ( Table 3 ) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 or “general category” ( Table 4 ) 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 awards.…”

Female Autoimmune Disorders with Infertility: A Narrative Review

“…Anti-phospholipid antibodies are heterogeneous antibodies, present in nearly 2-5% of reproductively-active females [31], 14% of females with recurrent first-trimester abortions [32], and 10% in females with unexplained sub-fertility and recurrent miscarriages [33]. They attack the negativelycharged phospholipids with a phospholipid-binding plasma protein (PLBP) [34].…”

“…ATA (anti-thyroglobulin and thyroid peroxidase antibodies) have been present in healthy females and are more frequent in those of reproductive (childbearing age) [17]. ATA accounted for 16%-20% of typical pregnant females and ladies undergoing assisted reproductive techniques (ARTs) compared to 20%-24% in females with recurrent pregnancy loss [32] and 45% of pregnant females with hypothyroidism [40].…”