The COVID‐19 pandemic potentially makes treatment of acute leukaemia more difficult. Most induction chemotherapy regimens for acute leukaemia lead to extended periods of cytopaenia and immunosuppression rendering patients vulnerable to opportunistic infections. As with many aspects of SARS‐CoV‐2, there is no universally accepted way of treating patients who present with acute leukaemia and associated infection.
Antiphospholipid syndrome (APS) is a prothrombotic autoimmune disease with heterogenous clinicopathological manifestations and is a well-established cause of acute ischaemic stroke (AIS) and transient ischaemic attack (TIA), particularly in younger patients. There is growing recognition of a wider spectrum of APS-associated cerebrovascular lesions, including white matter hyperintensities, cortical atrophy and infarcts, which may have clinically important neurocognitive sequalae. Diagnosis of APS-associated AIS / TIA requires expert review of clinical and laboratory information. Management also poses challenges, given the potential for substantial morbidity and recurrent thrombosis, additional risk conferred by conventional cardiovascular risk factors, and limitations in the evidence-base regarding optimal antithrombotic therapy for secondary prevention. In this review, we summarise key features of APS-associated cerebrovascular disorders, with focus on clinical and laboratory aspects of diagnostic evaluation, including practical guidance for antiphospholipid antibody (aPL) testing, and an overview of neuroimaging findings. The current status of prognostic markers is considered. We review the evidence base for antithrombotic treatment in APS-associated stroke and discuss ongoing uncertainties in this setting, including the optimal intensity of anticoagulation and efficacy of direct oral anticoagulants (DOACs). Clinical practice recommendations are provided, covering antithrombotic treatment, supportive management and options for anticoagulant-refractory cases, and we highlight the benefits of adopting a careful multidisciplinary team approach.
Limited evidence exists to guide the management of recurrent thrombosis occurring despite therapeutic anticoagulation in patients with thrombotic antiphospholipid syndrome (APS). In this case series, fondaparinux, with or without an antiplatelet agent, provided an effective and safe option in three patients with thrombotic APS, all two triple and one single positive for antiphospholipid antibodies, who had recurrent venous and/or arterial thromboembolism. Rituximab was also used in all patients. Recurrent events occurred despite therapeutic anticoagulation, including at high-intensity, with warfarin and subsequent low-molecular-weight heparin. There were no major bleeding events. Adjunctive therapies used for thrombosis included catheter-directed thrombolysis and rituximab.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.