EULAR recommendations for the management of antiphospholipid syndrome in adults.
Research article published in Annals of the rheumatic diseases (2019)
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.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
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.
Why This Matters for Hirudotherapy
This guideline formulated evidence-based recommendations for managing antiphospholipid syndrome (APS) in adults, detailing pharmacological strategies including low-dose aspirin, vitamin K antagonists, heparin, and hydroxychloroquine based on thrombotic and obstetric risk profiles. The abstract focuses entirely on conventional systemic anticoagulation and immunomodulatory therapies. For the American Society of Hirudotherapy, the management of severe hypercoagulable states is conceptually adjacent to the study of anticoagulant mechanisms. However, the abstract contains no mention of leeches, hirudotherapy, the leech secretome, or any localized anticoagulant therapy, making its relevance purely background.
Citation
EULAR recommendations for the management of antiphospholipid syndrome in adults.
Tektonidou et al. · Annals of the rheumatic diseases, 2019
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