Management of Thrombotic Antiphospholipid Syndrome

Research output: Contribution to journalArticle

Abstract

Persistent serum positivity for antiphospholipid antibodies (aPL) is required to diagnose antiphospholipid syndrome (APS), an autoimmune disease characterized by recurrent vascular thrombosis and/or pregnancy morbidity. The current therapeutic management of patients with thrombotic APS aims at preventing recurrences and long-term complications by attenuating the procoagulant state. There is overall consensus to reserve moderate-intensity anticoagulation to aPL-positive patients with a previous venous thrombosis; the therapeutic options for those with a history of arterial event comprise antiplatelet agents and high-intensity anticoagulation. Unfortunately, thrombotic occurrences might occur despite adequate anticoagulation, carrying a significant burden of morbidity and mortality. The management of refractory thrombotic APS and catastrophic APS is still not clear, warranting the issue of recommendations. Vitamin-K antagonists are limited by significant side effects, and a careful weighting of risks and benefits should be performed to reserve the optimal treatment to each patient. To overcome these limitations, novel oral anticoagulants have been introduced in the market, but their efficacy in thrombotic APS has still to be unraveled. The poor safety profile and the scarce efficacy of drugs acting on the coagulation cascade explain why novel therapeutic approaches are currently under investigation, to identify pharmacological tools specifically counteracting aPL-mediated prothrombotic effects.

Original languageEnglish
Pages (from-to)419-426
Number of pages8
JournalSeminars in Thrombosis and Hemostasis
Volume44
Issue number5
DOIs
Publication statusPublished - Jul 1 2018

Fingerprint

Antiphospholipid Syndrome
Antiphospholipid Antibodies
Morbidity
Vitamin K
Platelet Aggregation Inhibitors
Therapeutics
Venous Thrombosis
Anticoagulants
Autoimmune Diseases
Blood Vessels
Thrombosis
Pharmacology
Safety
Recurrence
Pregnancy
Mortality
Serum
Pharmaceutical Preparations

Keywords

  • antiphospholipid antibodies
  • antiphospholipid syndrome
  • thrombosis
  • treatment

ASJC Scopus subject areas

  • Hematology
  • Cardiology and Cardiovascular Medicine

Cite this

Management of Thrombotic Antiphospholipid Syndrome. / Chighizola, Cecilia Beatrice; Raimondo, Maria Gabriella; Meroni, Pier Luigi.

In: Seminars in Thrombosis and Hemostasis, Vol. 44, No. 5, 01.07.2018, p. 419-426.

Research output: Contribution to journalArticle

@article{38a10259521745f5ad2f86ca6c8e67c3,
title = "Management of Thrombotic Antiphospholipid Syndrome",
abstract = "Persistent serum positivity for antiphospholipid antibodies (aPL) is required to diagnose antiphospholipid syndrome (APS), an autoimmune disease characterized by recurrent vascular thrombosis and/or pregnancy morbidity. The current therapeutic management of patients with thrombotic APS aims at preventing recurrences and long-term complications by attenuating the procoagulant state. There is overall consensus to reserve moderate-intensity anticoagulation to aPL-positive patients with a previous venous thrombosis; the therapeutic options for those with a history of arterial event comprise antiplatelet agents and high-intensity anticoagulation. Unfortunately, thrombotic occurrences might occur despite adequate anticoagulation, carrying a significant burden of morbidity and mortality. The management of refractory thrombotic APS and catastrophic APS is still not clear, warranting the issue of recommendations. Vitamin-K antagonists are limited by significant side effects, and a careful weighting of risks and benefits should be performed to reserve the optimal treatment to each patient. To overcome these limitations, novel oral anticoagulants have been introduced in the market, but their efficacy in thrombotic APS has still to be unraveled. The poor safety profile and the scarce efficacy of drugs acting on the coagulation cascade explain why novel therapeutic approaches are currently under investigation, to identify pharmacological tools specifically counteracting aPL-mediated prothrombotic effects.",
keywords = "antiphospholipid antibodies, antiphospholipid syndrome, thrombosis, treatment",
author = "Chighizola, {Cecilia Beatrice} and Raimondo, {Maria Gabriella} and Meroni, {Pier Luigi}",
year = "2018",
month = "7",
day = "1",
doi = "10.1055/s-0036-1597282",
language = "English",
volume = "44",
pages = "419--426",
journal = "Seminars in Thrombosis and Hemostasis",
issn = "0094-6176",
publisher = "Thieme Medical Publishers",
number = "5",

}

TY - JOUR

T1 - Management of Thrombotic Antiphospholipid Syndrome

AU - Chighizola, Cecilia Beatrice

AU - Raimondo, Maria Gabriella

AU - Meroni, Pier Luigi

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Persistent serum positivity for antiphospholipid antibodies (aPL) is required to diagnose antiphospholipid syndrome (APS), an autoimmune disease characterized by recurrent vascular thrombosis and/or pregnancy morbidity. The current therapeutic management of patients with thrombotic APS aims at preventing recurrences and long-term complications by attenuating the procoagulant state. There is overall consensus to reserve moderate-intensity anticoagulation to aPL-positive patients with a previous venous thrombosis; the therapeutic options for those with a history of arterial event comprise antiplatelet agents and high-intensity anticoagulation. Unfortunately, thrombotic occurrences might occur despite adequate anticoagulation, carrying a significant burden of morbidity and mortality. The management of refractory thrombotic APS and catastrophic APS is still not clear, warranting the issue of recommendations. Vitamin-K antagonists are limited by significant side effects, and a careful weighting of risks and benefits should be performed to reserve the optimal treatment to each patient. To overcome these limitations, novel oral anticoagulants have been introduced in the market, but their efficacy in thrombotic APS has still to be unraveled. The poor safety profile and the scarce efficacy of drugs acting on the coagulation cascade explain why novel therapeutic approaches are currently under investigation, to identify pharmacological tools specifically counteracting aPL-mediated prothrombotic effects.

AB - Persistent serum positivity for antiphospholipid antibodies (aPL) is required to diagnose antiphospholipid syndrome (APS), an autoimmune disease characterized by recurrent vascular thrombosis and/or pregnancy morbidity. The current therapeutic management of patients with thrombotic APS aims at preventing recurrences and long-term complications by attenuating the procoagulant state. There is overall consensus to reserve moderate-intensity anticoagulation to aPL-positive patients with a previous venous thrombosis; the therapeutic options for those with a history of arterial event comprise antiplatelet agents and high-intensity anticoagulation. Unfortunately, thrombotic occurrences might occur despite adequate anticoagulation, carrying a significant burden of morbidity and mortality. The management of refractory thrombotic APS and catastrophic APS is still not clear, warranting the issue of recommendations. Vitamin-K antagonists are limited by significant side effects, and a careful weighting of risks and benefits should be performed to reserve the optimal treatment to each patient. To overcome these limitations, novel oral anticoagulants have been introduced in the market, but their efficacy in thrombotic APS has still to be unraveled. The poor safety profile and the scarce efficacy of drugs acting on the coagulation cascade explain why novel therapeutic approaches are currently under investigation, to identify pharmacological tools specifically counteracting aPL-mediated prothrombotic effects.

KW - antiphospholipid antibodies

KW - antiphospholipid syndrome

KW - thrombosis

KW - treatment

UR - http://www.scopus.com/inward/record.url?scp=85014755823&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85014755823&partnerID=8YFLogxK

U2 - 10.1055/s-0036-1597282

DO - 10.1055/s-0036-1597282

M3 - Article

C2 - 28278524

AN - SCOPUS:85014755823

VL - 44

SP - 419

EP - 426

JO - Seminars in Thrombosis and Hemostasis

JF - Seminars in Thrombosis and Hemostasis

SN - 0094-6176

IS - 5

ER -