Controversies in the Management of Antiphospholipid Syndrome

Abstract

Strategies to prevent thrombosis in antiphospholipid antibody (aPL)–positive patients are of the utmost importance. The risk of thrombosis in patients with aPLs varies, depending on additional venous thrombosis and cardiovascular risk factors, as well as associated comorbidities. Recurrent thrombosis despite treatment with vitamin K antagonists is relatively common in daily practice. In this context, the effectiveness of the new direct oral anticoagulants in antiphospholipid syndrome is debated, as well as that of low-dose aspirin for primary thromboprophylaxis. There is an urgent unmet need to recognize the subgroup of patients that may benefit from low-dose aspirin use. Here we also discuss different points of view on primary and secondary thrombosis preventions in aPL-positive patients, which were presented as a debate during the 2021 PANLAR Congress (Pan-American League of the Association of Rheumatology) and that was organized by GESAF (Argentine Society of Rheumatology APS Study Group). It is the intention of this article to provide a useful discussion to aid treatment decision-making in daily clinical practice.

Antiphospholipid Antibodies Associated with Native Arteriovenous Fistula Complications in Hemodialysis Patients: A Comprehensive Review of the Literature

“…Major bleeding complications have been associated with the use of VKA in the HD population [ 74 ]; VKA also have detrimental effects on AVF remodeling process by promoting intimal hyperplasia and calcification [ 75 ]. Despite the superior benefit-risk profile of direct oral anticoagulants versus VKA observed in the HD population, the use of the latter anticoagulant should be avoided because of the increased risk of arterial thrombosis in APS patients [ 76 ]. Low-molecular-weight-heparin could be a reasonable option in these patients.…”