Antiphospholipid syndrome secondary prevention: Difference between revisions
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==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: | 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> | ||
* Oral contraceptives use | * Oral contraceptives use | ||
* Smoking | * Smoking | ||
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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]
- 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.
| 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
- ↑ 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.
- ↑ 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.