Evolution of Antiphospholipid Syndrome.
| Autor: | Arachchillage DRJ; Department of Immunology and Inflammation, Centre for Haematology, Imperial College London, London, United Kingdom.; Department of Haematology, Imperial College Healthcare NHS Trust, London, United Kingdom., Pericleous C; National Heart and Lung Institute, Imperial College London, London, United Kingdom. |
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| Jazyk: | angličtina |
| Zdroj: | Seminars in thrombosis and hemostasis [Semin Thromb Hemost] 2023 Apr; Vol. 49 (3), pp. 295-304. Date of Electronic Publication: 2023 Jan 16. |
| DOI: | 10.1055/s-0042-1760333 |
| Abstrakt: | Antiphospholipid syndrome (APS) is an autoimmune prothrombotic disease characterized by thrombosis and/or pregnancy complications caused by antiphospholipid antibodies (aPL). The history of APS can be traced back to observations made during screening programs for syphilis conducted in the mid-20th century, with identification of patients with the so-called biological false-positive serological reactions for syphilis. Initial observation linking aPL with recurrent miscarriages was first reported more than 40 years ago. Since then, our understanding of the pathogenesis and management of APS has evolved markedly. Although APS is an autoimmune disease, anticoagulation mainly with vitamin K antagonists (VKAs) rather than immunomodulation, is the treatment of choice for thrombotic APS. Direct acting oral anticoagulants are inferior to VKAs, especially those with triple-positive APS and arterial thrombosis. Inflammation, complement activation, and thrombosis in the placenta may contribute to pathogenesis of obstetric APS. Heparin, mainly low-molecular-weight heparin, and low-dose aspirin represent the treatments of choice for women with obstetric complications. Increasingly, immunomodulatory agents such as hydroxychloroquine for thrombotic and obstetric APS are being used, especially in patients who are refractory to present standard treatment. Competing Interests: D.J.A. received funding from Bayer plc to setup the multicenter database of the study as an investigator-initiated funding and received research grant from Leo Pharma. C.P. has no conflict of interest to declare. (Thieme. All rights reserved.) |
| Databáze: | MEDLINE |
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