Current treatment strategies for management of antiphospholipid syndrome

Abstract

Introduction: Antiphospholipid syndrome (APS) is a systemic autoimmune disease representing the most frequent cause of acquired hypercoagulability and recurrent miscarriages. The disease has been known for at least 30 years, but its treatment is still a strongly debated topic for a number of reasons. First, it is difficult, if not impossible, to identify a univocal therapeutic regimen that will be effective for every patient, given the great clinical and serological heterogeneity of the disease. Second, it has been widely demonstrated that the positivity for antiphospholipid antibodies is not sufficient by itself to determine the clinical manifestations of the syndrome. Hence, the search for additional risk factors is needed in the critical analysis of the individual clinical setting in order to optimize the therapy. Third, a not negligible (notable) proportion of patients carry the resistant or recurrent form of the disease despite conventional treatments, showing the need for alternative therapeutic approaches.

Areas covered: The aim of this article was to review the available literature, trying to enucleate the most accepted therapies for both the primary and secondary prophylaxis of thrombosis and pregnancy morbidity.

Expert opinion: A brief discussion on the way we personally manage particular clinical settings of APS in our clinical practice has been provided.

Keywords::

• antiaggregation
• anticoagulation
• antiphospholipid antibodies
• antiphospholipid syndrome
• pregnancy complications
• pregnancy loss
• prophylaxis
• refractory antiphospholipid syndrome
• thrombosis

Notes

This box summarizes key points contained in the article.