Document Detail


Antiphospholipid syndrome.
MedLine Citation:
PMID:  16582686     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE OF REVIEW: To review the recently published studies that can guide physicians in the management of persistently antiphospholipid antibody (aPL)-positive patients. RECENT FINDINGS: Two recent prospective randomized controlled trials of two intensities of warfarin concluded that both moderate and high-intensity anticoagulation are similarly protective in antiphospholipid syndrome patients after the first thrombosis. Despite lack of controlled studies, there is experimental evidence that hydroxychloroquine and statins may play a role in the management of aPL-positive patients. In the mouse model of antiphospholipid syndrome that involves the injection of high-titer antiphospholipid syndrome human serum, complement activation is essential in aPL-mediated fetal loss and heparin prevents aPL-induced complement activation. SUMMARY: Primary thrombosis prevention in persistently aPL-positive individuals lacks an evidence-based approach; elimination of reversible thrombosis risk factors and prophylaxis during high-risk periods is crucial. Secondary thrombosis prevention in persistently aPL-positive individuals lacks a risk-stratified approach; although the current recommendation is life-long warfarin, the necessity, duration, and the intensity of warfarin are still debated. Catastrophic antiphospholipid syndrome patients usually receive a combination of anticoagulation, corticosteroids, intravenous immunoglobulin, and plasma exchange; there is a clear need to test new agents. A common strategy to prevent fetal loss in aPL-positive patients with history of pregnancy morbidities is low-dose aspirin and heparin; if patients fail this regimen, the next step is the addition of intravenous immunoglobulin although this is not supported by controlled studies. Currently, there is no evidence that anticoagulation is effective for nonthrombotic manifestations of antiphospholipid antibodies.
Authors:
Doruk Erkan; Michael D Lockshin
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Current opinion in rheumatology     Volume:  18     ISSN:  1531-6963     ISO Abbreviation:  Curr Opin Rheumatol     Publication Date:  2006 May 
Date Detail:
Created Date:  2006-04-03     Completed Date:  2008-07-31     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9000851     Medline TA:  Curr Opin Rheumatol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  242-8     Citation Subset:  IM    
Affiliation:
The Barbara Volcker Center for Women and Rheumatic Disease, Hospital for Special Surgery, and Weill Medical College of Cornell University, New York, USA. derkan@pol.net
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MeSH Terms
Descriptor/Qualifier:
Adult
Animals
Anticoagulants / therapeutic use
Antiphospholipid Syndrome* / drug therapy
Female
Humans
Mice
Pregnancy
Pregnancy Complications / therapy
Thrombosis / etiology,  prevention & control
Warfarin / therapeutic use
Chemical
Reg. No./Substance:
0/Anticoagulants; 81-81-2/Warfarin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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