Thromboprophylaxis and obstetric management of the antiphospholipid syndrome.
There is consensus in treating patients with antiphospholipid syndrome (APS) and first venous thrombosis with oral anticoagulation to a target international normalized ratio of 2.0 - 3.0. A recent systematic review recommended a target international normalized ratio > 3.0 in the group of patients with APS and arterial thrombosis. The approach for women with obstetric manifestations of APS is based on the use of aspirin plus heparin. In addition, we summarize the evidence-based information about management of catastrophic APS and some difficult cases, such as 'seronegative' APS, patients who do not display formal classification criteria for APS, and recurrent thrombotic events despite optimal anticoagulation.
Espinosa
Gerard
G
Hospital Clínic, Institut Clínic de Medicina i Dermatologia, Department of Autoimmune Diseases, Barcelona, Catalonia, Spain.
Cervera
Ricard
R
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D016736:Antiphospholipid Syndrome / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D001241:Aspirin / Q000627:therapeutic use*; D002388:Catastrophic Illness; D004359:Drug Therapy, Combination; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D009774:Obstetrics / Q000379:methods; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D020246:Venous Thrombosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D055815:Young Adult
D000925:Anticoagulants; D006493:Heparin; D001241:Aspirin