title: Treatment of Thrombotic Antiphospholipid Syndrome: The Rationale of Current Management-An Insight into Future Approaches.
abstract: Vascular thrombosis and pregnancy morbidity represent the clinical manifestations of antiphospholipid syndrome (APS), which is serologically characterized by the persistent positivity of antiphospholipid antibodies (aPL). Antiplatelet and anticoagulant agents currently provide the mainstay of APS treatment. However, the debate is still open: controversies involve the intensity and the duration of anticoagulation and the treatment of stroke and refractory cases. Unfortunately, the literature cannot provide definite answers to these controversial issues as it is flawed by many limitations, mainly due to the recruitment of patients not fulfilling laboratory and clinical criteria for APS. The recommended therapeutic management of different aPL-related clinical manifestations is hereby presented, with a critical appraisal of the evidence supporting such approaches. Cutting edge therapeutic strategies are also discussed, presenting the pioneer reports about the efficacy of novel pharmacological agents in APS. Thanks to a better understanding of aPL pathogenic mechanisms, new therapeutic targets will soon be explored. Much work is still to be done to unravel the most controversial issues about APS management: future studies are warranted to define the optimal management according to aPL risk profile and to assess the impact of a strict control of cardiovascular risk factors on disease control.
authors.affiliation: Immunology Research Laboratory, IRCCS Istituto Auxologico Italiano, Via Zucchi 18, 20095 Cusano Milanino, Italy ; Department of Clinical Sciences and Community Health, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy.
authors.forename: Cecilia Beatrice
authors.identifier: 0000-0002-3787-9632
authors.initials: CB
authors.lastname: Chighizola
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy ; Division of Rheumatology, Istituto Ortopedico Gaetano Pini, Piazza Cardinal Ferrari 1, 20122 Milan, Italy.
authors.forename: Tania
authors.initials: T
authors.lastname: Ubiali
authors.affiliation: Immunology Research Laboratory, IRCCS Istituto Auxologico Italiano, Via Zucchi 18, 20095 Cusano Milanino, Italy ; Department of Clinical Sciences and Community Health, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy ; Division of Rheumatology, Istituto Ortopedico Gaetano Pini, Piazza Cardinal Ferrari 1, 20122 Milan, Italy.
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Meroni
mesh_terms: D017152:Antibodies, Antiphospholipid / Q000276:immunology / Q000378:metabolism; D016736:Antiphospholipid Syndrome / Q000150:complications* / Q000453:epidemiology / Q000276:immunology / Q000628:therapy*; D015551:Autoimmunity; D002318:Cardiovascular Diseases / Q000209:etiology; D019468:Disease Management; D006801:Humans; D012306:Risk; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*
chemical_list: D017152:Antibodies, Antiphospholipid