Targeted therapy in antiphospholipid syndrome

Sciascia, Savino; Khamashta, Munther A.; D’Cruz, David

doi:10.1097/bor.0000000000000051

Cited by 19 publications

(18 citation statements)

References 71 publications

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“…Some experts may add another medication, such as low dose aspirin, hydroxychloroquine and/or statin. However, there is a lack of high-quality data to guide practice and there is no good-quality evidence to guide selection of a specific immunomodulatory agent for the treatment of APS [18,19]. It is also important to evaluate for other possible reversible thrombosis risk factors.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous regression of severe aortic stenosis after massive embolization in a patient with antiphospholipid syndrome

Youssef

Alrefae

Abouelsoud

2019

Seminars in Cardiovascular Medicine

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Summary We present a case of probably unreported aortic stenosis evolution in a patient with primary antiphospholipid syndrome (APS). A female patient, 54 years old, with a history of recurrent deep venous thrombosis, an episode of pulmonary embolism and was positive for APS antibodies. She was kept on warfarin and aspirin. The patient was admitted with acute pulmonary edema and severe aortic stenosis. While preparing for aortic valve surgery, the patient developed acute stroke, and a week later developed concurrent acute ischemia of both lower limbs. Emergency surgery salvaged the lower limbs and follow up transthoracic echocardiography showed marked regression of the thickening of the aortic valve leaflets, only mild aortic stenosis and moderate aortic regurgitation. Aortic valve surgery was cancelled, and the patient was kept on warfarin and aspirin. Conclusion Development of severe aortic stenosis is uncommon in primary APS, and this scenario of spontaneous improvement from a severe to a mild aortic stenosis, is probably unreported before.

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Section: Discussionmentioning

confidence: 99%

Spontaneous regression of severe aortic stenosis after massive embolization in a patient with antiphospholipid syndrome

Youssef

Alrefae

Abouelsoud

2019

Seminars in Cardiovascular Medicine

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“…Physicians should use LMWH, FON, or NOACs instead of UFH or warfarin to manage VTE in patients with APL syndrome. 90,91 …”

Section: Management Of Vte In Apl Syndromementioning

confidence: 98%

Practical Approach to VTE Management in Hospitalized Patients

Reddy

Dupree

2017

American Journal of Therapeutics

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Venous thromboembolism (VTE) is a commonly feared life-threatening complication in hospitalized patients. Physicians are frequently consulted to diagnose and manage VTE in obstetrics, neurology, and surgical services. VTE should be treated irrespective of the presentation (incidental or symptomatic), etiology (provoked vs. unprovoked), and location of the venous thrombosis (extremities, abdomen, or cerebral). In patients with high clinical suspicion for VTE, physicians are encouraged to empirically start anticoagulant therapy while awaiting diagnostic testing. Thrombolytic therapy is underused by physicians, which is proven to improve the mortality in hypotensive patients with pulmonary embolism. Retrievable inferior vena cava filters have an important role in the prophylaxis and management of selective groups of VTE patients. Physicians should not hesitate to place retrievable inferior vena cava filters when clinically indicated but also should make every effort to remove them when no longer needed. This article extensively reviews various diagnostic and management options based on several clinical situations.

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“…The EINSTEIN-PE and EINSTEIN-DVT trials are international multicenter randomized controlled trials that evaluated Rivaroxaban in the treatment and prevention of DVT and acute symptomatic PE. Large phase III clinical trials [45][46][47] demonstrated the efficacy of dabigatran and rivaroxaban and their low incidences of major bleeding compared to Warfarin in adults. However, these trials may not be directly applicable to patients with APS.…”

Section: Newer Anticoagulantsmentioning

confidence: 99%

“…Heparin appears to inhibit complement activation, and mice deficient in complement were resistant to thrombosis in aPL. However, no studies in humans exist except case reports detailing Eculizumab use in CAPS [45,59,60]. Hence, because data is needed to show definite benefit, the current recommendation reserves complement inhibition as adjuvant therapy in patients with refractory APS [44].…”

Section: Complement Inhibition (Eculizumab)mentioning

confidence: 99%

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Antiphospholipid Syndrome (APS) - An Update on Clinical Features and Treatment Options

Katikaneni¹,

Gangam²,

Berney³

et al. 2015

TOUNJ

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Antiphospholipid syndrome (APS) is an autoantibody disorder characterized by the presence of antiphospholipid (APL) antibodies and heterogeneous clinical manifestations. Patients may present with recurrent thrombosis, obstetric morbidity, cardiac valvular lesions, thrombocytopenia, skin lesions, renal or neurologic abnormalities. We provide a comprehensive review of these diverse clinical features except renal and obstetric complications. Treatment of APS can be challenging as one tries to balance the benefit of anticoagulation therapy in this hypercoagulable state while minimizing the risk of bleeding. We discuss the various therapeutic options including the role of aspirin, warfarin, low molecular weight heparin, new direct thrombin inhibitors, hydroxychloroquine, intravenous gamma globulin, rituximab and others. Lower risk APS patients (i.e. first venous thrombosis) should receive warfarin with a target INR of 2.0-3.0. Higher risk patients (i.e. arterial thrombosis or recurrent venous events) have a target INR of >3.0. Currently, warfarin remains the mainstay in treatment of APS. Because of lack of adequate data, the newer oral direct inhibitors should be considered only when there is a known allergy/ intolerance or poor control with warfarin. Additional vascular and thrombotic risk factors should be aggressively reduced. Further studies involving large number of APS patients, diagnosed according to accepted criteria, are needed to better define the role of newer anticoagulants and other novel therapies.

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Targeted therapy in antiphospholipid syndrome

Cited by 19 publications

References 71 publications

Spontaneous regression of severe aortic stenosis after massive embolization in a patient with antiphospholipid syndrome

Spontaneous regression of severe aortic stenosis after massive embolization in a patient with antiphospholipid syndrome

Practical Approach to VTE Management in Hospitalized Patients

Antiphospholipid Syndrome (APS) - An Update on Clinical Features and Treatment Options

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