Anticoagulant and non-anticoagulant therapy in thrombotic antiphospholipid syndrome: old drugs and new treatment targets.
Guillermo Ruiz-IrastorzaMaria G G TektonidouMunther KhamashtaPublished in: Rheumatology (Oxford, England) (2024)
In this review, we discuss the current evidence on classic and newer oral anticoagulant therapy, older drugs such as HCQ and statins, and new potential treatment targets in APS. Vitamin K antagonists (VKAs) remain the cornerstone treatment for thrombotic events in APS. In patients fulfilling criteria for definite APS presenting with a first venous thrombosis, treatment with VKAs with a target international normalized ratio (INR) 2.0-3.0 is recommended. In patients with arterial thrombosis, treatment with VKA with target INR 2.0-3.0 or 3.0-4.0 is recommended by recent guidelines, considering the individual's bleeding and thrombosis recurrence risk. A combination of VKAs and low-dose aspirin (75-100 mg/daily) may also be considered. According to available evidence direct oral anticoagulants should be avoided in patients with arterial thrombosis and/or those with triple aPL positivity. Adjunctive treatment with HCQ and/or statins can be considered, especially in anticoagulation treatment-refractory APS. Potential targeted treatments in APS include B-cell targeting, complement inhibition, mammalian target of rapamycin inhibition, IFN targeting, adenosine receptors agonists, CD38 targeting or chimeric antigen receptor T-cell therapy. The safety and efficacy of these treatment targets needs to be examined in well-designed randomized controlled trials.
Keyphrases
- low dose
- venous thromboembolism
- atrial fibrillation
- cell therapy
- randomized controlled trial
- physical activity
- cancer therapy
- stem cells
- acute coronary syndrome
- chronic kidney disease
- cardiovascular disease
- clinical trial
- combination therapy
- end stage renal disease
- direct oral anticoagulants
- pulmonary embolism
- drug delivery
- risk assessment
- high dose
- bone marrow
- climate change
- ejection fraction
- patient reported outcomes