Page 871 - Clinical Immunology_ Principles and Practice ( PDFDrive )

CHaPTEr 61 Antiphospholipid Syndrome 841

thrombosis prevention in aPL-positive patients. Experimental 5. Erkan D, Lockshin MD. What is antiphospholipid syndrome? Curr
evidence in APS mouse models and the clinical trials demonstrat- Rheumatol Rep 2004;6:451–7.
ing rosuvastatin’s protective effect against a first major cardio- 6. Betapudi V, Lominadze G, Hsi L, et al. Anti-β2GPI antibodies stimulate
vascular event and venous thrombosis in a general population endothelial cell microparticle release via a nonmuscle myosin II motor
protein-dependent pathway. Blood 2013;122:3808–17.
without hyperlipidemia but with elevated high-sensitivity 7. Girardi G, Berman J, Redecha P, et al. Complement C5a receptors and
24
C-reactive protein levels justifies clinical studies of statins in neutrophils mediate fetal injury in the antiphospholipid syndrome. J Clin
nonpregnant aPL-positive patients. Invest 2003;112:1644–54.
Antiplatelet agents other than aspirin or long-term LMWH 8. Roman MJ, Shanker BA, Davis A, et al. Prevalence and correlates of
treatment, empirically used, have not been formally tested in accelerated atherosclerosis in systemic lupus erythematosus. N Engl J
clinical trials. Ongoing prospective, randomized clinical trials Med 2003;349:2399–406.
investigating the role of the direct oral anticoagulants in the 9. Ruiz-Irastorza G, Crowther M, Branch W, et al. Antiphospholipid
treatment of thromboembolism in patients with APS are eagerly syndrome. Lancet 2010;376:1498–509.
awaited, and other strategies, including complement inhibitors 10. Erkan D, Espinosa G, Cervera R. Catastrophic antiphospholipid
and novel antithrombotic therapies, may be candidates for future syndrome: updated diagnostic algorithms. Autoimmun Rev 2010;10:74–9.
clinical trials. 11. Pengo V, Tripodi A, Reber G, et al. Update of the guidelines for lupus
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risk factors for thrombosis than anticardiolipin antibodies in the
ON THE HOriZON antiphospholipid syndrome: a systematic review of the literature. Blood
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Translational research in antiphospholipid Syndrome 13. Pengo V, Ruffatti A, Legnani C, et al. Incidence of a first thromboembolic
• A better understanding of the cellular mechanisms of antiphospholipid event in asymptomatic carriers of high-risk antiphospholipid antibody
antibody (aPL) mediated clinical events that will help us design more profile: a multicenter prospective study. Blood 2011;118:4714–18.
specifically targeted treatments. 14. Erkan D, Derksen WJ, Kaplan V, et al. Real world experience with
• Identification of patients who are at risk for future aPL-related events. antiphospholipid antibody tests: how stable are results over time? Ann
• Controlled studies of theoretically useful medications such as hydroxy-
chloroquine, statins, complement inhibitors, or anti-B-cell therapies. Rheum Dis 2005;64:1321–5.
15. Erkan D, Harrison MJ, Levy R, et al. Aspirin for primary thrombosis
prevention in the antiphospholipid syndrome: a randomized,
double-blind, placebo-controlled trial in asymptomatic antiphospholipid
APS is a systemic autoimmune disease consisting of thromboses, antibody-positive individuals. Arthritis Rheum 2007;56:2382–91.
pregnancy losses, and persistent high-titer aPL. Inflammation 16. Crowther MA, Ginsberg JS, Julian J, et al. A comparison of two intensities
and complement activation are established mechanisms of aPL- of warfarin for the prevention of recurrent thrombosis in patients with
related manifestations in murine models; however, definitive the antiphospholipid antibody syndrome. N Engl J Med 2003;349:1133–8.
studies in humans do not exist. The disease is too variable 17. Finazzi G, Marchioli R, Brancaccio V, et al. A randomized clinical trial of
high-intensity warfarin vs. conventional antithrombotic therapy for the
clinically, and its mechanisms too diverse, to expect that a single prevention of recurrent thrombosis in patients with the antiphospholipid
mechanism defined in a single model will apply to all aspects syndrome (WAPS). J Thromb Haemost 2005;3:848–53.
of this disease. Given that the mechanisms of aPL-induced 18. Levine SR, Brey RL, Tilley BC, et al. Antiphospholipid antibodies and
thrombosis are not well understood and that thrombosis is subsequent thrombo-occlusive events in patients with ischemic stroke.
multifactorial and that controversies exist about the strength of JAMA 2004;291:576–84.
association between aPL and clinical events, drug development 19. Cohen H, Hunt BJ, Efthymiou M, et al. Rivaroxaban versus warfarin to
specific for aPL-positive patients has been challenging. Antico- treat patients with thrombotic antiphospholipid syndrome, with or
agulation is the primary treatment today, but a future therapeutic without systemic lupus erythematosus (RAPS): a randomised, controlled,
approach will likely include immunomodulatory agents. open-label, phase 2/3, non-inferiority trial. Lancet Haematol
2016;3:e426–36.
20. Garcia D, Akl EA, Carr R, et al. Antiphospholipid antibodies and the risk
Please check your eBook at https://expertconsult.inkling.com/ of recurrence after a first episode of venous thromboembolism: a
for self-assessment questions. See inside cover for registration systematic review. Blood 2013;122:817–24.
details. 21. Erkan D, Vega J, Ramon G, et al. A pilot open-label phase II trial of
rituximab for non-criteria manifestations of antiphospholipid syndrome.
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