title: [Management of antiphospholipid syndrome].
abstract: The prevention of thrombosis in the antiphospholipid syndrome (APS) remains controversial. The purpose of this review is to provide updated recommendations. There is evidence that patients at risk of thrombosis are those with "a pattern of high risk antiphospholipid antibodies (aPL)" (presence of a lupus anticoagulant [LA], association of several aPL, or persistent aCL at a medium or high level), or those with associated systemic lupus erythematosus (SLE). The prescription of aspirin in primary prevention is recommended in SLE patients with positive LA or persistent aCL at a significant level. Secondary prevention is based on a very prolonged anticoagulation. An INR around 2.5 seems to be sufficient in patients with venous APS. In case of arterial events, the attitude is debated. We propose to maintain a target INR between 3 and 3.5. The possible occurrence of relapse despite anticoagulation in the therapeutic target may lead to the addition of aspirin. The development of new anti-thrombotic agents might change the management of APS in the coming years.
authors.affiliation: Service de médecine interne, centre de référence national pour le lupus et le syndrome des antiphospholipides, CHU Pitié-Salpêtrière, AP-HP, université Pierre-et-Marie-Curie-Paris-6, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France. david.saadoun@psl.aphp.fr
authors.forename: D
authors.initials: D
authors.lastname: Saadoun
authors.forename: J-C
authors.initials: JC
authors.lastname: Piette
authors.forename: D
authors.initials: D
authors.lastname: Wahl
authors.forename: N
authors.initials: N
authors.lastname: Costedoat-Chalumeau
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D017152:Antibodies, Antiphospholipid / Q000097:blood; D016736:Antiphospholipid Syndrome / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D001241:Aspirin / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D019317:Evidence-Based Medicine; D006801:Humans; D007155:Immunologic Factors / Q000097:blood; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013927:Thrombosis / Q000276:immunology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D017152:Antibodies, Antiphospholipid; D015415:Biomarkers; D007155:Immunologic Factors; D001241:Aspirin