Antiphospholipid syndrome

Definition:

Antiphospholipid syndrome (APS) is characterized by a variety of clinical and immunological manifestations. The clinical hallmarks of this syndrome are thrombosisand poor obstetric outcomes in the presence of antiphospholipid antibodies. APS can occur within the context of several diseases, mainly autoimmune disorders, and is then called secondary APS. About 40% of patients with systemic lupus erythematosus (SLE) have antiphospholipid antibodies, but less than 40% of them will eventually have thrombotic events. On the other hand, it may be also be present without any recognizable disease, or so-called primary APS. Pregnancy complications in APS, such as recurrent unexplained abortions, fetal loss, preeclampsia, and premature birth, have been attributed to placental thrombosis and infarcts, and management of these patients is based on attenuating the procoagulant state. Treatment with low-dose aspirin (LDA) and heparinoids has become a conventional option for pregnant women with APS. Possible future therapies for non-pregnant patients with antiphospholipid syndrome are statins, rituximab, and new anticoagulant drugs.

References:

[1]. Cecile M Yelnik, et al. Lupus anticoagulant is the main predictor of adverse pregnancy outcomes in aPL-positive patients: validation of PROMISSE study results. Lupus Sci Med. 2016 Jan 12;3(1):e000131. [Content Brief]

[2]. Eleftheria Lefkou, et al. Pravastatin improves pregnancy outcomes in obstetric antiphospholipid syndrome refractory to antithrombotic therapy. J Clin Invest. 2016 Aug 1;126(8):2933-40. [Content Brief]

[3]. Guillermo Ruiz-Irastorza, et al. Antiphospholipid syndrome. Lancet. 2010 Oct 30;376(9751):1498-509. [Content Brief]

[4]. Sefer Gezer, et al. Antiphospholipid syndrome. Dis Mon. 2003 Dec;49(12):696-741. [Content Brief]

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