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Current Rheumatology Reports

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01-11-2018 | Antiphospholipid Syndrome (S Zuily, Section Editor)

Primary Thrombosis Prophylaxis in Persistently Antiphospholipid Antibody-Positive Individuals: Where Do We Stand in 2018?

Authors: Yu Zuo, Medha Barbhaiya, Doruk Erkan

Published in: Current Rheumatology Reports | Issue 11/2018

Abstract

Purpose of review

To update our previous literature review and management recommendations on risk stratification and primary thrombosis prophylaxis in persistently antiphospholipid antibody (aPL)-positive individuals.

Recent Findings

The estimated annual thrombosis incident rate (ATIR) among aPL-positive individuals with or without systemic autoimmune disease (SAIDx) is 0 to 5.3%, probably very low (< 1%/year) in those with no other SAIDx and thrombosis risk factors. Risk stratification based on aPL profile, age, additional SAIDx, and traditional cardiovascular disease (CVD) or venous thrombosis risk factors is crucial to determine the risk of first thrombosis in aPL-positive patients. The protective effect of low-dose aspirin for primary thrombosis prophylaxis prevention is not supported by randomized controlled data. Hydroxychloroquine is protective against thrombosis in aPL-positive SLE patients; however, its role in aPL-positive individuals with other SAIDx remains uncertain. Statins downregulate proinflammatory and prothrombotic biomarkers among antiphospholipid syndrome (APS) patients and may have a role in aPL-positive individuals with high CVD risk.

Summary

The optimal primary thrombosis prevention strategy in patients with clinically significant aPL profiles should include (a) regular screening and elimination of non-aPL thrombosis risk factors, (b) optimal management of concomitant SAIDx, (c) patient counseling and education, and (d) use of CVD risk prediction tools and guidelines to perform risk-benefit calculations regarding low-dose aspirin, hydroxychloroquine, and/or statin therapy.

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Title: Primary Thrombosis Prophylaxis in Persistently Antiphospholipid Antibody-Positive Individuals: Where Do We Stand in 2018?
Authors: Yu Zuo
Medha Barbhaiya
Doruk Erkan
Publication date: 01-11-2018
Publisher: Springer US
Published in: Current Rheumatology Reports / Issue 11/2018
Print ISSN: 1523-3774
Electronic ISSN: 1534-6307
DOI: https://doi.org/10.1007/s11926-018-0775-8

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Primary Thrombosis Prophylaxis in Persistently Antiphospholipid Antibody-Positive Individuals: Where Do We Stand in 2018?

Abstract

Purpose of review

Recent Findings

Summary

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Abstract

Purpose of review

Recent Findings

Summary

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