Intensity and Duration of Anticoagulation Therapy in Antiphospholipid Syndrome

Abstract

Antithrombotic drugs are the therapeutic cornerstone for patients with antiphospholipid syndrome (APS) and thrombosis. Choosing the specific agent (vitamin K antagonists or antiplatelet drugs), the intensity of anticoagulation (e.g., international normalized ratio [INR] range 2.0 to 3.0 or 3.0 to 4.0), and the duration of treatment has been a recurrent matter of debate. A recent consensus document recommends warfarin to an INR range of 2.0 to 3.0 for patients with a first venous thromboembolic event. Higher anticoagulation intensity is recommended for patients presenting with arterial events. Combined therapy with warfarin and aspirin is another possibility, but some authors recommend standard intensity warfarin or aspirin, either as monotherapy. In general, a more intense regimen is warranted for high-risk patients. On the basis of an increased risk of recurrence during the first 6 months following warfarin withdrawal, long-term anticoagulation is considered the standard treatment. Nevertheless, anticoagulation regimes of shorter duration could be given in selected patients with venous thromboembolism who have transient risk factors and a low-risk profile.

Low-molecular-weight heparin and aspirin use in relation to pregnancy outcome in women with systemic lupus erythematosus and antiphospholipid syndrome: A cohort study

“…Aspirin is also often prescribed in women with SLE and/or primary APS without evidence from an RCT, since it prevents recurrent HD in other populations (7)(8)(9)(10). To our knowledge, differences in pregnancy outcomes in relation to the use of LMWH and aspirin between women with SLE without aPL, SLE with aPL, SLE with APS and primary APS have not been well described yet.…”

Neurological antiphospholipid syndrome: Clinical, neuroimaging, and pathological characteristics

“…Current treatment guidelines for APS emphasize the importance of early diagnosis and recommend aggressive therapies to alleviate damage to the CNS, especially to prevent recurrence of thrombosis [9][10][11]. However, the intensity and duration of anticoagulation therapy in APS syndrome have been debated for long [12][13][14]. Treatment for recurrent thrombosis in APS patients requires further clarification, since pathological studies on APS patients are scarce.…”

Decreased mean platelet volume in Gilbert's syndrome

“…1). These findings hold significance for patients being investigated for APS, as a false-negative lupus anticoagulant finding may lead to false exclusion of APS, and thus withholding of appropriate therapy, which for APS includes extended anticoagulant therapy [19].…”