Management of Cardiovascular Complications in Antiphospholipid Syndrome: A Narrative Review with a Focus on Older Adults.

Autor: Bernardi M; Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Piazzale A. Moro 5, 00185 Rome, Italy., Spadafora L; Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Piazzale A. Moro 5, 00185 Rome, Italy., Andaloro S; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy., Piscitelli A; Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy., Fornaci G; Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Piazzale A. Moro 5, 00185 Rome, Italy., Intonti C; Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Piazzale A. Moro 5, 00185 Rome, Italy., Fratta AE; Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy., Hsu CE; Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy., Kaziròd-Wolski K; Institute of Medical Sciences, Collegium Medicum, Jan Kochanowski University, Al. IX Wieków Kielc 19A, 25-317 Kielce, Poland., Metsovitis T; Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy., Biondi-Zoccai G; Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Via XXIV Maggio 7, 04100 Latina, Italy.; Cardiology Unit, Santa Maria Goretti Hospital, Via L. Scaravelli, 04100 Latina, Italy., Sabouret P; Heart Institute, Pitié-Salpétrière Hospital, Sorbonne University, 47-83 Bd. de l'Hôpital, 75013 Paris, France.; National College of French Cardiologists, 13 Niepce, 75014 Paris, France., Marzetti E; Department of Geriatrics, Orthopedics, and Rheumatology, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy.; Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy., Cacciatore S; Department of Geriatrics, Orthopedics, and Rheumatology, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy.
Jazyk: angličtina
Zdroj: Journal of clinical medicine [J Clin Med] 2024 May 23; Vol. 13 (11). Date of Electronic Publication: 2024 May 23.
DOI: 10.3390/jcm13113064
Abstrakt: Antiphospholipid syndrome (APS), also known as Hughes syndrome, is an acquired autoimmune and procoagulant condition that predisposes individuals to recurrent thrombotic events and obstetric complications. Central is the role of three types of antiphospholipid antibodies that target phospholipid-binding proteins: lupus anticoagulant (LAC), anti-β2-glycoprotein I (β2-GPI-Ab), and anti-cardiolipin (aCL). Together with clinical data, these antibodies are the diagnostic standard. However, the diagnosis of APS in older adults may be challenging and, in the diagnostic workup of thromboembolic complications, it is an underestimated etiology. The therapeutic management of APS requires distinguishing two groups with differential risks of thromboembolic complications. The standard therapy is based on low-dose aspirin in the low-risk group and vitamin K antagonists in the high-risk group. The value of direct oral anticoagulants is currently controversial. The potential role of monoclonal antibodies is investigated. For example, rituximab is currently recommended in catastrophic antiphospholipid antibody syndrome. Research is ongoing on other monoclonal antibodies, such as daratumumab and obinutuzumab. This narrative review illustrates the pathophysiological mechanisms of APS, with a particular emphasis on cardiovascular complications and their impact in older adults. This article also highlights advancements in the diagnosis, risk stratification, and management of APS.
Databáze: MEDLINE
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