Towards evidence-based treatment of thrombotic antiphospholipid syndrome

Abstract

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.

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

“…A direct comparison of the calculation of thrombotic (both venous and arterial) recurrence rates in studies concerning APS patients is quite difficult, because of the different classification criteria, laboratory cut off values, and the different therapeutic strategies [35]. However, an approximate thrombosis recurrence rate can be deduced from the above mentioned studies.…”

Detection of lupus anticoagulant in the presence of rivaroxaban using Taipan snake venom time

“…This treatment itself prolongs clotting assays and therefore interferes with the detection of the LAC. There is no consensus on the treatment of patients with APS [4,5] and there is room for alternative treatment. One of the recently developed anticoagulants is rivaroxaban, a direct factor Xa (FXa) inhibitor [6].…”

“…The linkage between inflammation and coagulation is a wellknown concept in the field of infectious diseases [4]. Epidemiological observations have clearly demonstrated an association between influenza epidemics and cardiovascular mortality [5].…”

Effective Management of Acute Coronary Thrombosis in a Young Woman with Lupus Using Aggressive Medical Therapy

“…In one case of a young woman with SLE and Libman-Sacks endocarditis, the extent of distal embolization was not amenable to PCI, and the patient was successfully treated with aggressive medical therapy [16]. Finally, a recent review of clinical data regarding thrombotic events in patients with APS concluded that the most important preventative measure may be aggressive antiplatelet therapy, supporting such an approach in the acute setting [17]. There are data in an animal model of lupus that support this approach of medical management; in mice with the lupus phenotype that have AMI, administration of high-dose ticlodipine increases survival [18].…”