Antiphospholipid syndrome secondary prevention: Difference between revisions
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==Overview== | ==Overview== | ||
The secondary prevention of antiphospholipid syndrome (APS) includes reduction of reversible risk factors such as [[smoking]], [[hypertension]], hyperlipidemia and life-long [[Anticoagulant|anticoagulation]] maintaining a target INR of 3.0-4.0 | |||
==Secondary Prevention== | ==Secondary Prevention== | ||
===Reduction of reversible risk factors=== | ===Reduction of reversible risk factors=== | ||
The following risk factors should be controlled for the secondary prevention of APS:<ref name="pmid21303837">{{cite journal| author=Ruiz-Irastorza G, Cuadrado MJ, Ruiz-Arruza I, Brey R, Crowther M, Derksen R et al.| title=Evidence-based recommendations for the prevention and long-term management of thrombosis in antiphospholipid antibody-positive patients: report of a task force at the 13th International Congress on antiphospholipid antibodies. | journal=Lupus | year= 2011 | volume= 20 | issue= 2 | pages= 206-18 | pmid=21303837 | doi=10.1177/0961203310395803 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21303837 }} </ref><ref name="pmid22315259">{{cite journal| author=Holbrook A, Schulman S, Witt DM, Vandvik PO, Fish J, Kovacs MJ et al.| title=Evidence-based management of anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. | journal=Chest | year= 2012 | volume= 141 | issue= 2 Suppl | pages= e152S-e184S | pmid=22315259 | doi=10.1378/chest.11-2295 | pmc=3278055 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22315259 }} </ref><ref name="pmid22313321">{{cite journal| author=Keeling D, Mackie I, Moore GW, Greer IA, Greaves M, British Committee for Standards in Haematology| title=Guidelines on the investigation and management of antiphospholipid syndrome. | journal=Br J Haematol | year= 2012 | volume= 157 | issue= 1 | pages= 47-58 | pmid=22313321 | doi=10.1111/j.1365-2141.2012.09037.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22313321 }} </ref> | |||
* Oral contraceptives use | |||
* Smoking | |||
* [[Hypertension]] | |||
* Hyperlipidemia | |||
* During the perioperative period, this may include minimizing the period when patients are off [[Anticoagulant|anticoagulation]]. | |||
* Initiating early ambulation | |||
* Measures to reduce [[Vein|venous]] stasis. | |||
=== Continuation of anticoagulation: === | |||
For patients with APS and a history of an unprovoked thrombotic event, lifelong [[Anticoagulant|anticoagulation]] is recommended.<ref name="pmid21303837" /><ref name="pmid22315259" /><ref name="pmid22313321" /> | |||
{| class="wikitable" | |||
! colspan="2" |Recommendations for secondary prophylaxis in patients with antiphospholipid antibodies and thrombosis | |||
|- | |||
|Patients with definite antiphospholipid syndrome and first venous event | |||
|Indefinite [[Anticoagulant|anticoagulation]] to a target INR* 2·0–3·0 | |||
|- | |||
|Patients with definite antiphospholipid syndrome and arterial event | |||
|Indefinite anticoagulation to a target INR 3·0–4·0 | |||
|- | |||
|Patients with definite antiphospholipid syndrome and recurrent events despite warfarin with a target intensity of 2·0–3·0 | |||
|Indefinite anticoagulation to a target INR 3·0–4·0 or alternative therapies such as extended therapeutic dose low-molecular-weight heparin | |||
|- | |||
|Patients with venous [[thromboembolism]] with single positive or low-titre antiphospholipid antibodies | |||
|As usual per recommendations for deep vein thrombosis treatment | |||
|- | |||
|Patients with arterial [[thrombosis]] with single positive or low-titre antiphospholipid antibodies | |||
|As usual per recommendations for arterial [[thrombosis]] | |||
|} | |||
<nowiki>*</nowiki>INR= International normalized ratio | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Disease]] | [[Category:Disease]] | ||
Latest revision as of 20:37, 24 April 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Feham Tariq, MD [2]
Overview
The secondary prevention of antiphospholipid syndrome (APS) includes reduction of reversible risk factors such as smoking, hypertension, hyperlipidemia and life-long anticoagulation maintaining a target INR of 3.0-4.0
Secondary Prevention
Reduction of reversible risk factors
The following risk factors should be controlled for the secondary prevention of APS:[1][2][3]
- Oral contraceptives use
- Smoking
- Hypertension
- Hyperlipidemia
- During the perioperative period, this may include minimizing the period when patients are off anticoagulation.
- Initiating early ambulation
- Measures to reduce venous stasis.
Continuation of anticoagulation:
For patients with APS and a history of an unprovoked thrombotic event, lifelong anticoagulation is recommended.[1][2][3]
| Recommendations for secondary prophylaxis in patients with antiphospholipid antibodies and thrombosis | |
|---|---|
| Patients with definite antiphospholipid syndrome and first venous event | Indefinite anticoagulation to a target INR* 2·0–3·0 |
| Patients with definite antiphospholipid syndrome and arterial event | Indefinite anticoagulation to a target INR 3·0–4·0 |
| Patients with definite antiphospholipid syndrome and recurrent events despite warfarin with a target intensity of 2·0–3·0 | Indefinite anticoagulation to a target INR 3·0–4·0 or alternative therapies such as extended therapeutic dose low-molecular-weight heparin |
| Patients with venous thromboembolism with single positive or low-titre antiphospholipid antibodies | As usual per recommendations for deep vein thrombosis treatment |
| Patients with arterial thrombosis with single positive or low-titre antiphospholipid antibodies | As usual per recommendations for arterial thrombosis |
*INR= International normalized ratio
References
- ↑ 1.0 1.1 Ruiz-Irastorza G, Cuadrado MJ, Ruiz-Arruza I, Brey R, Crowther M, Derksen R; et al. (2011). "Evidence-based recommendations for the prevention and long-term management of thrombosis in antiphospholipid antibody-positive patients: report of a task force at the 13th International Congress on antiphospholipid antibodies". Lupus. 20 (2): 206–18. doi:10.1177/0961203310395803. PMID 21303837.
- ↑ 2.0 2.1 Holbrook A, Schulman S, Witt DM, Vandvik PO, Fish J, Kovacs MJ; et al. (2012). "Evidence-based management of anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 141 (2 Suppl): e152S–e184S. doi:10.1378/chest.11-2295. PMC 3278055. PMID 22315259.
- ↑ 3.0 3.1 Keeling D, Mackie I, Moore GW, Greer IA, Greaves M, British Committee for Standards in Haematology (2012). "Guidelines on the investigation and management of antiphospholipid syndrome". Br J Haematol. 157 (1): 47–58. doi:10.1111/j.1365-2141.2012.09037.x. PMID 22313321.