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EULAR recommendations for the management of antiphospholipid syndrome in adults

Tektonidou, Maria G, Andreoli, Laura, Limper, Marteen, Amoura, Zahir, Cervera, Ricard, Costedoat-Chalumeau, Nathalie, Cuadrado, Maria Jose, Dörner, Thomas, Ferrer-Oliveras, Raquel, Hambly, Karen, and others. (2019) EULAR recommendations for the management of antiphospholipid syndrome in adults. Annals of the Rheumatic Diseases, . ISSN 0003-4967. (doi:10.1136/annrheumdis-2019-215213)

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Abstract

The objective was to develop evidence-based recommendations for the management of antiphospholipid syndrome (APS) in adults. Based on evidence from a systematic literature review and expert opinion, overarching principles and recommendations were formulated and voted. High-risk antiphospholipid antibody (aPL) profile is associated with greater risk for thrombotic and obstetric APS. Risk modification includes screening for and management of cardiovascular and venous thrombosis risk factors, patient education about treatment adherence, and lifestyle counselling. Low-dose aspirin (LDA) is recommended for asymptomatic aPL carriers, patients with systemic lupus erythematosus without prior thrombotic or obstetric APS, and non-pregnant women with a history of obstetric APS only, all with high-risk aPL profiles. Patients with APS and first unprovoked venous thrombosis should receive long-term treatment with vitamin K antagonists (VKA) with a target international normalised ratio (INR) of 2–3. In patients with APS with first arterial thrombosis, treatment with VKA with INR 2–3 or INR 3–4 is recommended, considering the individual’s bleeding/thrombosis risk. Rivaroxaban should not be used in patients with APS with triple aPL positivity. For patients with recurrent arterial or venous thrombosis despite adequate treatment, addition of LDA, increase of INR target to 3–4 or switch to low molecular weight heparin may be considered. In women with prior obstetric APS, combination treatment with LDA and prophylactic dosage heparin during pregnancy is recommended. In patients with recurrent pregnancy complications, increase of heparin to therapeutic dose, addition of hydroxychloroquine or addition of low-dose prednisolone in the first trimester may be considered. These recommendations aim to guide treatment in adults with APS. High-quality evidence is limited, indicating a need for more research.

Item Type: Article
DOI/Identification number: 10.1136/annrheumdis-2019-215213
Uncontrolled keywords: Antiphospholipid Syndrome; Adult; Guidelines
Subjects: R Medicine > RM Therapeutics. Pharmacology > RM695 Physical therapy
R Medicine > RZ Other systems of medicine
Divisions: Faculties > Sciences > School of Sport and Exercise Sciences
Depositing User: Karen Hambly
Date Deposited: 17 May 2019 11:20 UTC
Last Modified: 30 May 2019 22:05 UTC
Resource URI: https://kar.kent.ac.uk/id/eprint/73955 (The current URI for this page, for reference purposes)
Hambly, Karen: https://orcid.org/0000-0002-3442-2493
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