Estimated Frequency of Antiphospholipid Antibodies in Patients With Pregnancy Morbidity, Stroke, Myocardial Infarction, and Deep Vein Thrombosis: A Critical Review of the Literature

Andréoli, Laura; Chighizola, Cecilia Beatrice; Banzato, Alessandra; Pons-Estel, Guillermo J.; Jesus, Guilherme Ramire de; Erkan, Doruk

doi:10.1002/acr.22066

Cited by 289 publications

(212 citation statements)

References 10 publications

(14 reference statements)

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“…Antiphospholipid syndrome Around 10% of venous thromboembolic events occur in the context of the antiphospholipid syndrome (APS); 40 this patient subgroup was not specifically addressed in the VTE treatment trials and would not have entered the placebo controlled extension studies. A randomised clinical study comparing rivaroxaban and warfarin in over 100 APS patients with previous VTE showed the endogenous thrombin potential to be increased but the peak thrombin to be reduced in the rivaroxaban arm after 42 days of treatment.…”

Section: Cancermentioning

confidence: 99%

Drug therapy in anticoagulation: which drug for which patient?

Millar

Laffan

2017

Clinical Medicine

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Four non-vitamin K oral anticoagulants (NOACs) are now licensed and available in the UK, offering unprecedented choices in anticoagulant therapy for clinicians and patients. NOACs have many clear benefi ts over warfarin, the most striking being the reduction in intracranial haemorrhage. However, a number of uncertainties remain: their effi cacy in certain situations, utility of drug assays, signifi cance of drug interactions and management of bleeding. In the absence of any direct comparative trials, it is not clear that any of the NOACs is signifi cantly better than the others in any of the licensed indications. The differential activities, pharmacokinetics, metabolism, excretion and side effects of the agents should be considered when selecting the most appropriate anticoagulant. In this article, we discuss how, with careful selection for the relevant indication, NOACs can simplify therapy while improving outcomes. We aim to provide clinicians with the information needed to select the most suitable anticoagulant drug for an individual patient in a given situation. KEYWORDS : Anticoagulant therapy , non-vitamin K oral anticoagulants , NOACs IntroductionThe non-vitamin K oral anticoagulants (NOACs) 1 are now established in UK practice and new members continue to arrive. Within their licensed indications they have clear benefits over warfarin, but a number of uncertainties remain: efficacy in some specific situations, the utility of drug assays, significance of drug interactions and the management of bleeding all suffer from a paucity of data.This article provides an update on developments since the 2014 review in this journal.2 Our aim is to provide the information needed to select the most suitable anticoagulant drug for an individual patient in a given situation. ABSTRACTDrug therapy in anticoagulation: which drug for which patient? Properties of NOACsFour NOACs are now licensed and available in the UK: the direct factor Xa (FXa) inhibitors apixaban, edoxaban and rivaroxaban, and the direct thrombin inhibitor dabigatran. The key to best choice of agent lies in their individual pharmacokinetic profiles, metabolism and routes of excretion.

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Section: Cancermentioning

confidence: 99%

Drug therapy in anticoagulation: which drug for which patient?

Millar

Laffan

2017

Clinical Medicine

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“…This wide variation is due to different laboratory tests used for diagnosis. Andreoli et al [18] observed APA in 6 % women on analysis of 120 papers published in literature prior to year 2000. In contrast, in a study on 81 women with recurrent spontaneous abortion the prevalence of APA was found to be 16 % [19].…”

Section: Discussionmentioning

confidence: 99%

Lupus Anticoagulants and Anticardiolipin Antibodies in Indian Women with Spontaneous, Recurrent Fetal Loss

Rawat

Sikka

Rusia

et al. 2014

Indian J Hematol Blood Transfus

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Spontaneous and recurrent pregnancy loss are common complications of pregnancy resulting from varied causes including antiphospholipid syndrome (APS). Treatment of women with APS increases the chance of a subsequent successful pregnancy. The study aimed to find the prevalence of lupus anticoagulants (LA) and anticardiolipin antibodies (ACAs) in women with spontaneous/ recurrent fetal loss and compare with women with normal obstetric history. Hundred women with spontaneous/ recurrent fetal loss and 50 healthy pregnant controls were tested for LA by complete blood counts, Prothrombin time, Activated partial thromboplastin time (APTT), LA sensitive APTT and dilute Russell viper venom time (dRVVT) (screening and confirmatory) and ACAs (ELISA). LA was detected in 15 % patients using dRVVT confirmatory test and ACA in 5 %, all controls being negative. Twenty one % patients were detected by LA sensitive APTT (sensitivity 92.9 %, specificity 100 %) and 100 % with dRVVT screening test (sensitivity 98.8 %, specificity 100 %). We recommend that screening for antiphospholipid antibodies must be done in women with spontaneous/recurrent foetal loss even in the absence of other clinical manifestations using a combination of tests.

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“…16,17 In view of the inconveniences related to use of VKA and the advantages offered by DOAs, it is natural that there is interest in employing the newer drugs to treat APS as well. It has been estimated that around 10% of patients with DVT have APS, 35 from which it can be deduced that there were probably patients with APS enrolled on studies of DOAs. However, considering that these studies did not systematically document aPL status, their results cannot be generalized to patients with APS.…”

Section: -34mentioning

confidence: 99%

A importância de reconhecer a síndrome antifosfolípide na medicina vascular

et al. 2017

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Antiphospholipid syndrome (APS) is a systemic autoimmune disease characterized by recurrent arterial or venous thrombosis and/or gestational morbidity and by the presence of antiphospholipid antibodies. It can also cause other vascular manifestations such as microangiopathy, chronic arteriopathy and catastrophic APS (CAPS). Certain laboratory tests for the syndrome (for example, the lupus anticoagulant test) can be affected by the use of anticoagulant agents, making diagnosis more difficult. The pathophysiology of APS is complex, and several mechanisms of pathogenesis related to coagulation, endothelium, and platelets are discussed in this article. We conclude by discussing treatment of APS according to the presence and type of clinical manifestations, use of direct oral anticoagulants (DOAs), and perioperative management of patients with APS.Keywords: antiphospholipid syndrome; lupus anticoagulant; anticardiolipin antibodies; thrombosis; autoimmunity. ResumoA síndrome antifosfolipíde (SAF) é uma doença autoimune sistêmica caracterizada por trombose arterial ou venosa recorrente e/ou morbidade gestacional e pela presença dos anticorpos antifosfolipídeos, podendo apresentar outras manifestações vasculares, como microangiopatia, arteriopatia crônica e SAF catastrófica. Determinados testes laboratoriais para a síndrome (por exemplo, o anticoagulante lúpico) podem sofrer interferência do uso de medicações anticoagulantes, dificultando o diagnóstico. A fisiopatologia da SAF é complexa, sendo enumerados no texto diversos mecanismos patogênicos relacionados à coagulação, ao endotélio e às plaquetas. Por fim, discutimos o tratamento da SAF de acordo com a presença e o tipo de manifestações clínicas, o uso dos anticoagulantes orais diretos e o manejo perioperatório de pacientes com SAF.Palavras-chave: síndrome antifosfolípide; anticoagulante do lúpus; anticorpos anticardiolipina; trombose; autoimunidade.

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Estimated Frequency of Antiphospholipid Antibodies in Patients With Pregnancy Morbidity, Stroke, Myocardial Infarction, and Deep Vein Thrombosis: A Critical Review of the Literature

Cited by 289 publications

References 10 publications

Drug therapy in anticoagulation: which drug for which patient?

Drug therapy in anticoagulation: which drug for which patient?

Lupus Anticoagulants and Anticardiolipin Antibodies in Indian Women with Spontaneous, Recurrent Fetal Loss

A importância de reconhecer a síndrome antifosfolípide na medicina vascular

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