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The prophylaxis and treatment of antiphospholipid syndrome – current options, difficulties and future perspectives


Authors: A. Buliková 1,2;  P. Smejkal 1,2;  J. Kissová 1,2;  G. Chlupová 1;  M. Matýšková 1;  M. Šlechtová 1
Authors‘ workplace: Oddělení klinické hematologie FN Brno, přednosta prof. MUDr. Miroslav Penka, CSc. 1;  Lékařská fakulta MU Brno, děkan prof. MUDr. Jiří Mayer, CSc. 2
Published in: Vnitř Lék 2012; 58(7 a 8): 110-122
Category: 60th Birthday prof. MUDr. Miroslav Penka, CSc.

Overview

The antiphospholipid syndrome is the most frequent acquired thrombophilia. However, not only thromboembolic events belong to possible clinical manifestations which are caused by antiphospholid antibodies presence. Patients could also suffer from pregnancy loss and/or wide spectrum of non-thromboembolic complications. The paper summarizes current treatment options and recommendations, their difficulties and brings new visions for the future.

Key words:
antiphospholipid syndrome – prophylaxis – treatment – perspectives


Sources

1. Giannakopoulos B, Passam F, Ioannou Y et al. How we diagnose the antiphospholipid syndrome. Blood 2009; 113: 985–994.

2. Miyakis S, Lockshin MD, Atsumi T et al. International consensus statement on update of an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 2006; 4: 295–306.

3. Galli M, Reber G, de Moerloose P et al. Invitation to a debate on the serological criteria that define the antiphopsholipid syndrome. J Thromb Haemost 2008; 6: 399–401.

4. Swadźba J, Iwaniec T, Szczeklik A et al. Revised classification criteria for antiphospholipid syndrome and the thrombotic risk in patients with autoimmune disease. J Thromb Haemost 2007; 5: 1883–1889.

5. Swadźba J, Musial J. Letters to the Editor. More on: The debate on antiphospholipid syndrome classification criteria. J Thromb Haemost 2009; 7: 501–502.

6. Ruffatti A, Olivieri S, Tonello M et al. Influence of different IgG anticardiolipin antibody cut-off values on antiphospholipid syndrome classification. J Thromb Haemost 2008; 6: 1693–1696.

7. Ruffatti A, Pengo V. Antipospholipid syndrome classification criteria: comments to the Letter of Jakub Swadźba and Jacek Musial. J Thromb Haemost 2009; 7: 503–504.

8. Tripodi A. More on: criteria to define the antiphospholipid syndrome. J Thromb Haemost 2008; 6: 1049–1050.

9. Buliková A, Zavřelová J, Penka M. Antifosfolipidový syndrom v roce 2009. Vnitř Lék 2009; 55: 253–262.

10. Erkan D, Lockshin MD. Antiphospholipid syndrome. Curr Opin Rheumatol 2006; 18: 242–248.

11. Cohen HM, Machin SJ. Antithrombotic treatment failures in antiphospholipid syndrome: the new anticoagulants? Lupus 2010; 19: 486–491.

12. Branch DW, Khamashta MA. Antiphospholipid syndrome: obstetric diagnosis, management, and controversies. Obstet Gynecol 2003; 101: 1333–1344.

13. Manganelli R, Innaccone S, Manganelli S et al. Update on antiphospholipid syndrome management. In: Buliková A (ed.). Antiphospholipid syndrome. Rieka: Intech 2012: 175–196.

14. Merjian A, Lim W. ASH evidence-based guide­lines: should asymptomatic patients with antiphosholipid antibodies receive primary prophylaxis to prevent thromobosis? Hematology Am Soc Hematol Educ Program 2009; 247–249.

15. Keeling D, Mackie I, Moore GW et al. British Committee for standards in haematology. Guide­lines on the investigation and management of antiphospholipid syndrome. Br J Haematol 2012; 157: 47–58.

16. Erkan D, Harrison MJ, Levy R et al. Aspirin for primary thrombosis prevention in the antiphospholipid syndrome: a randomized, double--blind, placebo-controlled trial in asymptomatic antiphospholipid antibody-positive individuals. Arthritis Rheum 2007; 56: 2982–2391.

17. Tarr T, Lakos G, Bhattoa HP et al. Analysis of risk factors for the development of thrombotic complications in antiphospholipid antibody positive lupus patients. Lupus 2007; 16: 39–45.

18. Pengo V, Ruffatti A, Legnani C et al. Clinical course of high-risk patients diagnosed with antiphospholipid syndrome. J Thromb Haemost 2010; 8: 237–242.

19. Cuadrado MJ, Mujic F, Muñoz E et al. Thrombocytopenia in the antiphospholipid syndrome. Ann Rheum Dis 1997; 56: 194–196.

20. Finazzi G. The Italian registry of antiphospholipid antibodies. Haematologica 1997; 82: 101–105.

21. Trenfield S, Parmar K, Hunt BJ. Monitoring heparin in patients with a lupus anticoagulant: detection of heparin resistance. J Thromb Haemost 2008; 6: 1980–1982.

22. Buliková A. Trombocytopenie u pacientů s průkazem antifosfolipidových protilátek nebo s antifosfolipidovým syndromem. Vntiř Lék 2010; 56 (Suppl 1): S81–S90.

23. Arnout J. The pathogenesis of the antiphospholipid syndrome: a hypothesis based on parallelisms with heparin-induces thrombocytopenia. Thromb Haemost 1996; 75: 536–541.

24. Gruel Y, Rupin A, Watier H et al. Anticardio­lipin antibodies in heparin-associated thrombocytopenia. Thromb Res 1992; 67: 601–606.

25. Socher I, Kroll H, Jorsk S et al. Heparin-independent activation of platelet by heparin-induced thrombocytopenia antibodies: a common occurrence. J Throm Haemost 2008; 6: 197–200.

26. Pauzner R, Greinacher A, Selleng K et al. False-positive tests for heparin-induced thrombocytopenia in patients with antiphospholipid syndrome and systemic lupus erythematosus. J Tromb Haemost 2009; 7: 1070–1074.

27. Martion-Toutain I, Piette JC, Diemert MC et al. High prevalence of antibodies to platelet factor 4 heparin in patients with antiphospholipid antibodies in absence of heparin induced thrombocytopenia. Lupus 2007; 16: 79–83.

28. Lo GK, Sigouin CS, Warkentin TE. What is the potential overdiagnosis of heparin-induced thrombocytopenia. Am J Hematol 2007; 82: 1037–1043.

29. Warkentin TE. Antiphospholipid and anti-PF4 antibodies: an association affecting anti-PF4/heparin assay analysis. J Throm Haemost 2009; 7: 1067–1069.

30. Greinacher A. Heparin-Induced thrombocytopenia. J Thromb Haemost 2009; 7 (Suppl 1): 9–12.

31. Lo GK, Juhl D, Warkentin TE et al. Evaluation of pretest clinical score (4T’s) for the diagnosis of heparin-induced thrombocytopenia in two clinical settings. J Thromb Haemost 2006; 4: 759–765.

32. Rosove MH, Brewer PM. Antiphospholipid thrombosis: clinical course after the first thrombotic events in 70 patients. Ann Inter Med 1992; 117: 303–308.

33. Khamashta MA, Curado MJ, Mujic F et al. The management of thrombosis in the antiphospholipid syndrome. N Engl J Med 1995; 332: 993–997.

34. Crowther MA, Ginsberg JS, Julian J et al. A comparison of two intensities of warfarin for the prevention of recurrent thrombosis in patients with the antiphospholipid antibody syndrome. N Engl J Med 2003; 349: 1133–1138.

35. Finazzi G, Marchioli R, Brancaccio V et al. A randomized clinical trial of high-intensity warfarin vs. conventional antithrombotic therapy for the prevention of recurrent thrombosis in patient with antiphospholipid antibody synd­-rome (WAPS). J Thromb Hemost 2005; 3: 848–853.

36. Ames PR, Ciampa A, Margaglione M et al. Bleeding and re-thrombosis in primary antiphospholipid syndrome on oral anticoagulation. An 8-year longitudinal comparison with mitral valve replacement and inherited thrombophilia. Thromb Haemost 2005; 93: 694–699.

37. Wittkowsky AK, Downing J, Blackburn J et al. Warfarin-relatied outcomes in patients with antiphospholipid antibody syndrome managed in an anticoagulation clinic. Thromb Haemost 2006; 96: 137–141.

38. Kearon C, Julian JA, Kovacs MJ et al. ELATE investigators. Influence of thrombophilia on risk of recurrent venous thromboembolism while on warfarin: results from a randomized trial. Blood 2008; 112: 4432–4436.

39. Lim W, Crowther MA, Eikelboom JW. Management of antiphospholipid syndrome. A systematic review. JAMA 2006; 295: 1050–1057.

40. Giannakopoulos B, Krilis SA. How I treat the antiphospholipid syndrome. Blood 2009; 114: 2020–2030.

41. Kearon C, Akl AE, Comerota AJ et al. American College of Chest Physicians. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (2 Suppl): e419S–e494S.

42. Schulman S, Svenungsson E, Granvist S. Duration of anticoagulation study group. Anticardiolipin antibodies predict early recurrence of thromboembolism and death among pa­tients with venous thromboembolism following anticoagulant therapy. Am J Med 1998; 104: 332–338.

43. Büller HR, Agnelli G, Hull RD et al. Antithrombotic Therapy for venous thromboembolic disease: the Seventh ACCP Conference onAnti­thrombotic and Thrombolytic Therapy. Chest 2004; 126 (3 Suppl): 401S–428S.

44. Lawrie AS, Purdy G, Mackie IJ et al. Monitoring of oral anticoagulant therapy in lupus anticoagulant positive patients with the anti-phospholipid syndrome. Br J Haematol 1997; 98: 887–892.

45. Moll S, Ortel TL. Monitoring warfarin therapy in patients with lupus anticoagulants. Ann Intern Med 1997; 127: 177–185.

46. Arnout J, Vermylen J. Lupus anticoagulant: Influence on the International normalized ratio. Thromb Haemost 1999; 81: 847–849.

47. Robert A, Le Querrec A, Delahousse B et al. Control of oral anticoagulation in patients with the antiphospholipid syndrome – influence of the lupus anticoagulant on International normalized ratio. Groupe Méthodologie en Hémostase du Groupe d’Etudes sur l’Hémostases et la Thrombose. Tromb Haemost 1998; 80: 99–103.

48. Tripodi A, Chantarangkul V, Clerici M et al. Laboratory control of oral anticoagulant treatment by the INR system in patients with the anti­phospholipid syndrome and lupus anticoagulant. Results of a collaborative study involving nine commercials thromboplastins. Br J Haematol 2001; 115: 672–678.

49. Carrasco C, Campbell B, Shiach C. Effects of the lupus anticoagulants on the control of oral anticoagulant treatment. Br J Haematol 2004; 124: 555–563.

50. Buliková A, Némethová D, Penka M et al. Ovlivňuje přítomnost lupus antikoagulans antikoagulační léčbu u pacientů s antifosfolipidovým syndromem? Transfuze Hematol dnes 2005; 11: 148–153.

51. Khamashta MA. Management of thrombosis in the antiphospholipid syndrome. In: Khamashta MA (ed.). Hughes Syndrome. London: Springer-Verlag 2000: 391–396.

52. Levine SR, Brey RL, Tilley BC et al. APASS Investigators. Antiphospholipid antibodies and subsequent thrombo-occlusive events in patient with ischemic stroke. JAMA 2004; 291: 576–584.

53. Okuma H, Kitagawa Y, Yasuda T et al. Comparison between single antiplatelet therapy and combination of antiplatelet and anticoagulation therapy for secondary prevention in ischemic stroke patients with antiphospholipid syndrome. Int J Med Sci 2009; 7: 15–18.

54. Lansberg MG, O’Donnell MJ, Khatri P et al. American College of Chest Physicians. Antithrombotic a thrombolytic therapy for ischemic stroke: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (2 Suppl): e601S–e636S.

55. Ruiz-Irastorza G, Hunt BJ, Khamashta MA. A systemic review of secondary thromboprophylaxis in patients with antiphospholipid antibodies. Arthritis Rheumatism 2007; 57: 1487–1495.

56. Buliková A, Penka M. Selhání antikoagulační léčby. Vnitř Lék 2006; 52 (Suppl 1): 107–118.

57. Dentali F, Manfredi E, Crowther M et al. Long-duration therapy with low molecular weight heparin in patients with antiphospholipid antibody syndrome resistant to warfarin therapy. J Thromb Haemost 2005; 3: 2121–2123.

58. Statkute L, Traynor A, Oyama Y et al. Anti­phospholipid syndrome in patients with systemic lupus erythematosus treated by autologous hematopoietic stem cell transplantation. Blood 2005; 106: 2700–2709.

59. Cervera R, Piette JC, Font J et al. Antiphospholipid syndrome: clinical and immunological manifestations and patterns of disease expresion in a cohort of 1,000 patients. Arthritis Rheumat 2002; 46: 1019–1927.

60. Vora SK, Aherson RA, Erkan D. Catastrophic antiphospholipid syndrome. J Intensive Care 2006; 21: 144–159.

61. Erkan D, Lockshin MD. Non-criteria manifestation of antiphospholipid syndrome. Lupus 2010; 19: 424–427.

62. Caraba A, Crisan V, Munteanu A et al. The kidney in antiphospholipid syndrome. In: Bulikova A (ed.). Antiphospholipid syndrome. Rieka: Intech 2012: 125–138.

63. Buliková A, Penka M. Antifosfolipidový syndrom – diagnostika a léčba. Vnitř Lék 2005; 51: 809–817.

64. Korkmaz G, Kabukcuoğlu S, Isiksoy S et al. Renal involvement in primary antiphospholipid syndrome and its response to immunosuppressive therapy. Lupus 2003; 12: 760–765.

65. Espinosa-Zavaleta N, Montes RM, Soto ME et al. Primary antiphospholipid syndrome: a 5-year transesophageal echocardiographic follow up study. Am Heart J 1999; 137: 974–979.

66. Atsumi T, Furukawa S, Amengual O et al. Antiphospholipid antibody associated thrombocytopenia and the paradoxical risk of thrombosis. Lupus 2005; 14: 499–504.

67. Opatrny L, David M, Kahn SR et al. Association between antiphospholipid antibodies and recurrent fetal loss in women without autoimmune disease: a metaanalysis. J Rheumatol 2006; 33: 2214–2221.

68. Bates SM, Geer IA, Middeldrop S et al. American College of Chest Physicians. VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (2 Suppl); e691S–e736S.

69. Empson M, Lassere M, Craig J et al. Prevention of recurrent miscarriage for women with antiphospholipid antibodies or lupus anticoagulant. Cochrane Database Syst Rev 2005; CD002859.DOI: 10.1002/14651858.CD002859.pub2.

70. Clark CA, Spitzer KA, Crowther MA et al. Incidence of postpartum thrombosis and preterm delivery in women with antiphospholipid antibodies and recurrent pregnancy loss. J Rheumatol 2007; 34: 992–996.

71. Branch DW, Silver RM, Porter TF. Obstetric antiphospholipid syndrome: current uncertainties should guide our way. Lupus 2010; 19: 446–452.

72. Segovia AG, Rodríquez-Mahou M, Caballero P et al. Antiphospholipid antibodies in women with recurrent gestational failure – controversies in management. In: Buliková A (ed.). Antiphospholipid syndrome. Rieka: Intech 2012; 151–160.

73. Parravacini V, Caserta S. The immunomodulatory roles of vitamin D3: New tricks for an old dog. Mol Interv 2010; 10: 204–208.

74. Rotar Z, Rozman B, de Groot PG et al. Sixth meeting of the European forum on antiphospholipid antibodies. How to improve the understanding of the antiphospholipid syndrome. Lupus 2009; 18: 53–60.

75. Pierangeli SS, Erkan D. Antiphopholipid syndrome treatment beyond anticoagulation: are we there yet? Lupus 2010; 19: 475–485.

76. Murthy V, Erkan D, Jajoria P et al. Effects of Fluvastatin on Pro-Inflammatory and Pro-Thrombotic Markers in Antiphospholipid Antibody (aPL)-Positive Patients: Preliminary Results from an Open-Label Prospective Pilot Study. Arthritis Rheum 2011; 63: 283.

77. Cuadrado MJ, Lopez-Pedrera C, Aguirre A et al. Changes Operated in Protein Pattern of Monocytes from Patients with Antiphospholipid Syndrome Treated with Statins. Arthritis Rheum 2007; 56: S782.

78. Goldfine AB. Statins: is it really time to reassess benefits and risks? N Engl J Med 2012; 366: 1752–1755.

79. Rand JH, Wu X, Quicnn AS et al. Hydroxychloroquine directly reduces the binding of antiphospholipid antibody-β2-glycoprotein I complexes to phospholipid bilayers. Blood 2008; 112: 1687–1695.

80. Rand JH, Wu X, Quinn AS et al. Hydroxycholoquine protects the annexin A5 anticoagulant shield from disruption by antiphospholipid antibodies: evidence for a novel effect for an old antimalarial drug. Blood 2010; 115: 2292–2299.

81. Ruiz-Irastorza G, Egurbide MV, Pijoan JI et al. Effect of antimalarials on thrombosis and survival in patients with systemic lupus erythrmatosus. Lupus 2006; 15: 577–583.

82. Erkan D, Yazici Y, Peterson MG et al. A cross-sectional study of clinical risk factors and preventive treatments in antiphospholipid syndrome. Rheumatology 2002; 41: 924–929.

83. Erre GL, Pardini S, Faedda R et al. Effect of rituximab on clinical a laborator features of antiphospholipid syndrome: a case report and rewiev of literature. Lupus 2008; 17: 50–55.

84. Mehdi AA, Uthman I, Khamashta M. Anti­phospholipid syndrome: pathogenesis and a windouw of treatment opportunities in the future. Eur J Clin Invest 2010: 40: 451–464.

85. Schulman S, Kearon C, Kakkar AK et al. RE-COVER Study Group. Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med 2009; 361: 2342–2352.

86. The EINSTEIN Investigators. Oral Rivaroxaban for Symptomatic Venous Thromboembolism. N Engl J Med 2010; 363: 2499–2510.

87. Cohen H, Machin SJ. Antithrombotic treatment failures in antiphospholipid syndrome: the new anticoagulants? Lupus 2010: 19: 486–491.

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