nach oben

Current Rheumatology Reports

Erschienen in:

01.05.2016 | Antiphospholipid Syndrome (S Zuily, Section Editor)

Prevention of Recurrent Thrombosis in Antiphospholipid Syndrome: Different from the General Population?

verfasst von: Kimberly Janet Legault, Amaia Ugarte, Mark Andrew Crowther, Guillermo Ruiz-Irastorza

Erschienen in: Current Rheumatology Reports | Ausgabe 5/2016

Einloggen, um Zugang zu erhalten

Abstract

Antiphospholipid syndrome (APS) is characterized by arterial and/or venous thrombosis with or without pregnancy morbidity in the presence of autoantibodies targeting proteins that associate with membrane phospholipids, termed “antiphospholipid antibodies” (aPL). Management of arterial and venous thromboses shares some similarities with management of arterial and venous thromboses in the general population; however, there are key differences. The majority of studies addressing management of thrombotic APS focus on secondary prevention. Vitamin K antagonists (VKA) are typically used for secondary prevention of venous thromboembolism in APS. Optimal management of isolated arterial thrombosis, in particular ischemic stroke, in patients with APS is controversial, and proposed therapeutic options have included antiplatelet agents and VKA. Primary prophylaxis in aPL-positive patients should be an individualized decision taking into account patient-specific risks. There may be a role for adjuvant therapies such as hydroxychloroquine, vitamin D, statins, or novel therapeutics in specific patient populations.

Hoxha A, Ruffatti A, Tonello M, Bontadi A, Salvan E, Banzato A, et al. Antiphosphatidylserine/prothrombin antibodies in primary antiphospholipid syndrome. Lupus. 2012;21:787–9.CrossRefPubMed

van den Hoogen LL, van Roon JAG, Radstake TRDJ, Fritsch-Stork RDE, Derksen RHWM. Delineating the deranged immune system in the antiphospholipid syndrome. Autoimmun Rev. 2015. (Epub ahead of print)

Franco J-S, Molano-González N, Rodríguez-Jiménez M, Acosta-Ampudia Y, Mantilla RD, Amaya-Amaya J, et al. The coexistence of antiphospholipid syndrome and systemic lupus erythematosus in Colombians. PLoS ONE. 2014;9:e110242.CrossRefPubMedPubMedCentral

McMahon MA, Keogan M, O'Connell P, Kearns G. The prevalence of antiphospholipid antibody syndrome among systemic lupus erythematosus patients. Ir Med J. 2006;99:296–8.PubMed

Gómez-Puerta JA, Martín H, Amigo M-C, Aguirre MA, Camps MT, Cuadrado MJ, et al. Long-term follow-up in 128 patients with primary antiphospholipid syndrome: do they develop lupus? Medicine (Baltimore). 2005;84:225–30.CrossRef

Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J. Thromb. Haemost. 2006;6:295–306.

Reynaud Q, Lega J-C, Mismetti P, Chapelle C, Wahl D, Cathébras P, et al. Risk of venous and arterial thrombosis according to type of antiphospholipid antibodies in adults without systemic lupus erythematosus: a systematic review and meta-analysis. Autoimmun Rev. 2014;13:595–608.CrossRefPubMed

Wahl DG, Bounameaux H, de Moerloose P, Sarasin FP. Prophylactic antithrombotic therapy for patients with systemic lupus erythematosus with or without antiphospholipid antibodies: do the benefits outweigh the risks? A decision analysis. Arch Intern Med. 2000;160:2042–8.CrossRefPubMed

Galli M, Luciani D, Bertolini G, Barbui T. Lupus anticoagulants are stronger risk factors for thrombosis than anticardiolipin antibodies in the antiphospholipid syndrome: a systematic review of the literature. Blood. 2003;101:1827–32.CrossRefPubMed

10.

Pengo V, Biasiolo A, Pegoraro C, Cucchini U, Noventa F, Iliceto S. Antibody profiles for the diagnosis of antiphospholipid syndrome. Thromb Haemost. 2005;93:1147–52.PubMed

11.

Rosove MH, Brewer PM. Antiphospholipid thrombosis: clinical course after the first thrombotic event in 70 patients. Ann Intern Med. 1992;117:303–8.CrossRefPubMed

12.

Sciascia S, Sanna G, Murru V, Roccatello D, Khamashta MA, Bertolaccini ML. Anti-prothrombin (aPT) and anti-phosphatidylserine/prothrombin (aPS/PT) antibodies and the risk of thrombosis in the antiphospholipid syndrome. A systematic review. Thromb Haemost. 2014;111:354–64.CrossRefPubMed

13.

Otomo K, Atsumi T, Amengual O, Fujieda Y, Kato M, Oku K, et al. Efficacy of the antiphospholipid score for the diagnosis of antiphospholipid syndrome and its predictive value for thrombotic events. Arthritis Rheum. 2012;64:504–12.CrossRefPubMed

14.

Danowski A, de Azevedo MNL, de Souza Papi JA, Petri M. Determinants of risk for venous and arterial thrombosis in primary antiphospholipid syndrome and in antiphospholipid syndrome with systemic lupus erythematosus. J Rheumatol. 2009;36:1195–9.CrossRefPubMed

15.

Matyja-Bednarczyk A, Swadźba J, Iwaniec T, Sanak M, Dziedzina S, Ćmiel A, et al. Risk factors for arterial thrombosis in antiphospholipid syndrome. Thromb Res. 2014;133:173–6.CrossRefPubMed

16.

Ruffatti A, Del Ross T, Ciprian M, Nuzzo M, Rampudda M, Bertero MT, et al. Risk factors for a first thrombotic event in antiphospholipid antibody carriers. A multicentre, retrospective follow-up study. Ann Rheum Dis. 2009;68:397–9.CrossRefPubMed

17.

Ruffatti A, Del Ross T, Ciprian M, Bertero MT, Sciascia S, Salvatore S, et al. Risk factors for a first thrombotic event in antiphospholipid antibody carriers: a prospective multicentre follow-up study. Ann Rheum Dis. 2011;70:1083–6.CrossRefPubMed

18.

Urbanus RT, Siegerink B, Roest M, Rosendaal FR, de Groot PG, Algra A. Antiphospholipid antibodies and risk of myocardial infarction and ischaemic stroke in young women in the RATIO study: a case-control study. Lancet Neurol. 2009;8:998–1005.CrossRefPubMed

19.

Girón-González JA, García del Río E, Rodríguez C, Rodríguez-Martorell J, Serrano A. Antiphospholipid syndrome and asymptomatic carriers of antiphospholipid antibody: prospective analysis of 404 individuals. J Rheumatol. 2004;31:1560–7.PubMed

20.

Caldas CA, da Mota LMH, de Carvalho JF. Obesity in primary antiphospholipid syndrome is associated with worse outcome. Joint Bone Spine. 2011;78:324–5.CrossRefPubMed

21.

Bazzan M, Vaccarino A, Stella S, Sciascia S, Montaruli B, Bertero MT, et al. Patients with antiphosholipid syndrome and thrombotic recurrences: a real world observation (the Piedmont cohort study). Lupus. 2015;0:1–7.

22.

Chung W-S, Lin C-L, Kao C-H. Diabetes increases the risk of deep-vein thrombosis and pulmonary embolism. A population-based cohort study. Thromb Haemost. 2015;114:812–8.CrossRefPubMed

23.

Abdollahi M, Cushman M, Rosendaal FR. Obesity: risk of venous thrombosis and the interaction with coagulation factor levels and oral contraceptive use. Thromb Haemost. 2003;89:493–8.PubMed

24.

Pomp ER, le Cessie S, Rosendaal FR, Doggen CJM. Risk of venous thrombosis: obesity and its joint effect with oral contraceptive use and prothrombotic mutations. Br J Haematol. 2007;139:289–96.CrossRefPubMed

25.•

Sciascia S, Sanna G, Murru V, Roccatello D, Khamashta MA, Bertolaccini ML. The global anti-phospholipid syndrome score in primary APS. Rheumatology (Oxford). 2015;54:134–8. This article validates the use of GAPSS in a cohort of primary APS patients.CrossRef

26.

Jiménez S, Tàssies D, Espinosa G, García-Criado A, Plaza J, Monteagudo J, et al. Double heterozygosity polymorphisms for platelet glycoproteins Ia/IIa and IIb/IIIa increases arterial thrombosis and arteriosclerosis in patients with the antiphospholipid syndrome or with systemic lupus erythematosus. Ann Rheum Dis. 2008;67:835–40.CrossRefPubMed

27.

Berman H, Ugarte-Gil MF, Espinosa G, Tàssies D, Monteagudo J, Reverter JC, et al. Can inherited thrombophilia modulate the clinical phenotype of patients with antiphospholipid syndrome? Clin Exp Rheumatol. 2013;31:926–32.PubMed

28.

Keeling D, Mackie I, Moore GW, Greer IA, Greaves M, British Committee for Standards in Haematology. Guidelines on the investigation and management of antiphospholipid syndrome. Br J Haematol. 2012;157:47–58.

29.

National Clinical Guideline Centre (UK). Venous thromboembolic diseases: the management of venous thromboembolic diseases and the role of thrombophilia testing. London: Royal College of Physicians (UK); 2012.

30.

Brey RL. Antiphospholipid antibodies in young adults with stroke. J Thromb Thrombolysis. 2005;20:105–12.CrossRefPubMed

31.

Schulman S, Svenungsson E, Granqvist S. Anticardiolipin antibodies predict early recurrence of thromboembolism and death among patients with venous thromboembolism following anticoagulant therapy. Duration of Anticoagulation Study Group. Am J Med. 1998;104:332–8.CrossRefPubMed

32.

Kearon C, Gent M, Hirsh J, Weitz J, Kovacs MJ, Anderson DR, et al. A comparison of three months of anticoagulation with extended anticoagulation for a first episode of idiopathic venous thromboembolism. N Engl J Med. 1999;340:901–7.CrossRefPubMed

33.

Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, et al. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141:e419S–94S.CrossRefPubMedPubMedCentral

34.

Garcia D, Akl EA, Carr R, Kearon C. Antiphospholipid antibodies and the risk of recurrence after a first episode of venous thromboembolism: a systematic review. Blood. 2013;122:817–24.CrossRefPubMed

35.

Crowther MA, Ginsberg JS, Julian J, Denburg J, Hirsh J, Douketis J, et al. A comparison of two intensities of warfarin for the prevention of recurrent thrombosis in patients with the antiphospholipid antibody syndrome. N Engl J Med. 2003;349:1133–8.CrossRefPubMed

36.

Finazzi G, Marchioli R, Brancaccio V, Schinco P, Wisloff F, Musial J, et al. A randomized clinical trial of high-intensity warfarin vs. conventional antithrombotic therapy for the prevention of recurrent thrombosis in patients with the antiphospholipid syndrome (WAPS). J Thromb Haemost. 2005;3:848–53.CrossRefPubMed

37.

Ruiz-Irastorza G, Cuadrado MJ, Ruiz-Arruza I, Brey R, Crowther M, Derksen R, et al. 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. 2011;20:206–18.CrossRefPubMed

38.

Vargas-Hitos JA, Ateka-Barrutia O, Sangle S, Khamashta MA. Efficacy and safety of long-term low molecular weight heparin in patients with antiphospholipid syndrome. Ann Rheum Dis. 2011;70:1652–4.CrossRefPubMed

39.

Signorelli F, Nogueira F, Domingues V, Mariz HA, Levy RA. Thrombotic events in patients with antiphospholipid syndrome treated with rivaroxaban: a series of eight cases. Clin. Rheumatol. 2015. (Epub ahead of print)

40.

Son M, Wypasek E, Celinska-Lowenhoff M, Undas A. The use of rivaroxaban in patients with antiphospholipid syndrome: a series of 12 cases. Thromb Res. 2015;135:1035–6.CrossRefPubMed

41.

Schaefer JK, McBane RD, Black DF, Williams LN, Moder KG, Wysokinski WE. Failure of dabigatran and rivaroxaban to prevent thromboembolism in antiphospholipid syndrome: a case series of three patients. Thromb Haemost. 2014;112:947–50.CrossRefPubMed

42.

Win K, Rodgers GM. New oral anticoagulants may not be effective to prevent venous thromboembolism in patients with antiphospholipid syndrome. Am J Hematol. 2014;89:1017.CrossRefPubMed

43.

Noel N, Dutasta F, Costedoat-Chalumeau N, Bienvenu B, Mariette X, Geffray L, et al. Safety and efficacy of oral direct inhibitors of thrombin and factor Xa in antiphospholipid syndrome. Autoimmun Rev. 2015;14:680–5.CrossRefPubMed

44.

Cohen H, Doré CJ, Clawson S, Hunt BJ, Isenberg D, Khamashta M, et al. Rivaroxaban in antiphospholipid syndrome (RAPS) protocol: a prospective, randomized controlled phase II/III clinical trial of rivaroxaban versus warfarin in patients with thrombotic antiphospholipid syndrome, with or without SLE. Lupus. 2015;24:1087–94.CrossRefPubMedPubMedCentral

45.

Rivaroxaban for antiphospholipid syndrome—clinicaltrials.gov [Internet]. clinicaltrials.gov. [cited 2016 Feb 13]. Available from: https://www.clinicaltrials.gov/ct2/show/NCT02116036?term=rivaroxaban+antiphospholipid&rank=1

46.

Rivaroxaban in thrombotic antiphospholipid syndrome (TRAPS)—clinicaltrials.gov [Internet]. clinicaltrials.gov. [cited 2016 Feb 13]. Available from: https://www.clinicaltrials.gov/ct2/show/NCT02157272?term=rivaroxaban+antiphospholipid&rank=2

47.

Levine SR, Brey RL, Tilley BC, Thompson JLP, Sacco RL, Sciacca RR, et al. Antiphospholipid antibodies and subsequent thrombo-occlusive events in patients with ischemic stroke. JAMA. 2004;291:576–84.CrossRefPubMed

48.

Okuma H, Kitagawa Y, Yasuda T, Tokuoka K, Takagi S. Comparison between single antiplatelet therapy and combination of antiplatelet and anticoagulation therapy for secondary prevention in ischemic stroke patients with antiphospholipid syndrome. Int J Med Sci. 2009;7:15–8.PubMedPubMedCentral

49.

Ruiz-Irastorza G, Hunt BJ, Khamashta MA. A systematic review of secondary thromboprophylaxis in patients with antiphospholipid antibodies. Arthritis Rheum. 2007;57:1487–95.CrossRefPubMed

50.

Carter AE, Eban R. Prevention of postoperative deep venous thrombosis in legs by orally administered hydroxychloroquine sulphate. Br Med J. 1974;3:94–5.CrossRefPubMedPubMedCentral

51.

Wu TK, Tsapogas MJ, Jordan FR. Prophylaxis of deep venous thrombosis by hydroxychloroquine sulfate and heparin. Surg Gynecol Obstet. 1977;145:714–8.PubMed

52.

Snook GA, Chrisman OD, Wilson TC. Thromboembolism after surgical treatment of hip fractures. Clin. Orthop. Relat. Res. 1981; 21–4.

53.

Cooke ED, Dawson MH, Ibbotson RM, Bowcock SA, Ainsworth ME, Pilcher MF. Failure of orally administered hydroxychloroquine sulphate to prevent venous thromboembolism following elective hip operations. J Bone Joint Surg Am. 1977;59:496–500.PubMed

54.

Loudon JR. Hydroxychloroquine and postoperative thromboembolism after total hip replacement. Am J Med. 1988;85:57–61.CrossRefPubMed

55.

Erkan D, Yazici Y, Peterson MG, Sammaritano L, Lockshin MD. A cross-sectional study of clinical thrombotic risk factors and preventive treatments in antiphospholipid syndrome. Rheumatology (Oxford). 2002;41:924–9.CrossRef

56.

Schmidt-Tanguy A, Voswinkel J, Henrion D, Subra JF, Loufrani L, Rohmer V, et al. Antithrombotic effects of hydroxychloroquine in primary antiphospholipid syndrome patients. J Thromb Haemost. 2013;11:1927–9.PubMed

57.••

Arnaud L, Mathian A, Devilliers H, Ruffatti A, Tektonidou M, Forastiero R, et al. Patient-level analysis of five international cohorts further confirms the efficacy of aspirin for the primary prevention of thrombosis in patients with antiphospholipid antibodies. Autoimmun Rev. 2015;14:192–200. A meta-analysis that points to a protective effect of aspirin both for SLE patients with antiphospholipid antibodies and asymptomatic carriers of antiphospholipid antibodies.CrossRefPubMed

58.

Vaarala O, Alfthan G, Jauhiainen M, Leirisalo-Repo M, Aho K, Palosuo T. Crossreaction between antibodies to oxidised low-density lipoprotein and to cardiolipin in systemic lupus erythematosus. Lancet. 1993;341:923–5.CrossRefPubMed

59.

George J, Afek A, Gilburd B, Blank M, Levy Y, Aron-Maor A, et al. Induction of early atherosclerosis in LDL-receptor-deficient mice immunized with beta2-glycoprotein I. Circulation. 1998;98:1108–15.CrossRefPubMed

60.

George J, Harats D, Gilburd B, Afek A, Levy Y, Schneiderman J, et al. Immunolocalization of beta2-glycoprotein I (apolipoprotein H) to human atherosclerotic plaques: potential implications for lesion progression. Circulation. 1999;99:2227–30.CrossRefPubMed

61.

Meroni PL, Raschi E, Testoni C, Borghi MO. Endothelial cell activation by antiphospholipid antibodies. Clin Immunol. 2004;112:169–74.CrossRefPubMed

62.

Ferrara DE, Swerlick R, Casper K, Meroni PL, Vega-Ostertag ME, Harris EN, et al. Fluvastatin inhibits up-regulation of tissue factor expression by antiphospholipid antibodies on endothelial cells. J Thromb Haemost. 2004;2:1558–63.CrossRefPubMed

63.

Ridker PM, Danielson E, Fonseca FAH, Genest J, Gotto AM, Kastelein JJP, et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008;359:2195–207.CrossRefPubMed

64.

Erkan D, Willis R, Murthy VL, Basra G, Vega J, Ruiz-Limón P, et al. A prospective open-label pilot study of fluvastatin on proinflammatory and prothrombotic biomarkers in antiphospholipid antibody positive patients. Ann Rheum Dis. 2014;73:1176–80.CrossRefPubMedPubMedCentral

65.

Glynn RJ, Danielson E, Fonseca FAH, Genest J, Gotto AM, Kastelein JJP, et al. A randomized trial of rosuvastatin in the prevention of venous thromboembolism. N Engl J Med. 2009;360:1851–61.CrossRefPubMedPubMedCentral

66.

Pai M, Evans NS, Shah SJ, Green D, Cook D, Crowther MA. Statins in the prevention of venous thromboembolism: a meta-analysis of observational studies. Thromb Res. 2011;128:422–30.CrossRefPubMed

67.•

Erkan D, Vega J, Ramón G, Kozora E, Lockshin MD. A pilot open-label phase II trial of rituximab for non-criteria manifestations of antiphospholipid syndrome. Arthritis Rheum. 2013;65:464–71. The first clinical trial of Rituximab in APS.CrossRefPubMed

68.

Ahn ER, Lander G, Bidot CJ, Jy W, Ahn YS. Long-term remission from life-threatening hypercoagulable state associated with lupus anticoagulant (LA) following rituximab therapy. Am J Hematol. 2005;78:127–9.CrossRefPubMed

69.

Chalam KV, Gupta SK, Agarwal S. Rituximab effectively reverses papilledema associated with cerebral venous sinus thrombosis in antiphospholipid antibody syndrome. Eur J Ophthalmol. 2007;17:867–70.PubMed

70.

Hadaya K, Ferrari-Lacraz S, Fumeaux D, Boehlen F, Toso C, Moll S, et al. Eculizumab in acute recurrence of thrombotic microangiopathy after renal transplantation. Am J Transplant. 2011;11:2523–7.CrossRefPubMed

71.

Lonze BE, Zachary AA, Magro CM, Desai NM, Orandi BJ, Dagher NN, et al. Eculizumab prevents recurrent antiphospholipid antibody syndrome and enables successful renal transplantation. Am J Transplant. 2014;14:459–65.CrossRefPubMed

72.

Eculizumab for CAPS patients undergoing renal transplantation—clinicaltrials.gov [Internet]. clinicaltrials.gov. [cited 2016 Feb 14]. Available from: https://clinicaltrials.gov/ct2/show/NCT01029587?term=catastrophic+antiphospholipid&rank=1

73.

Andreoli L, Piantoni S, Dall'Ara F, Allegri F, Meroni PL, Tincani A. Vitamin D and antiphospholipid syndrome. Lupus. 2012;21:736–40.CrossRefPubMed

74.

Agmon-Levin N, Blank M, Zandman-Goddard G, Orbach H, Meroni PL, Tincani A, et al. Vitamin D: an instrumental factor in the anti-phospholipid syndrome by inhibition of tissue factor expression. Ann Rheum Dis. 2011;70:145–50.CrossRefPubMed

75.

Finazzi G, Brancaccio V, Moia M, Ciaverella N, Mazzucconi MG, Schinco PC, et al. Natural history and risk factors for thrombosis in 360 patients with antiphospholipid antibodies: a four-year prospective study from the Italian Registry. Am J Med. 1996;100:530–6.CrossRefPubMed

76.

Erkan D, Harrison MJ, Levy R, Peterson M, Petri M, Sammaritano L, et al. Aspirin for primary thrombosis prevention in the antiphospholipid syndrome: a randomized, double-blind, placebo-controlled trial in asymptomatic antiphospholipid antibody-positive individuals. Arthritis Rheum. 2007;56:2382–91.CrossRefPubMed

77.

Cuadrado MJ, Bertolaccini ML, Seed PT, Tektonidou MG, Aguirre A, Mico L, et al. Low-dose aspirin vs low-dose aspirin plus low-intensity warfarin in thromboprophylaxis: a prospective, multicentre, randomized, open, controlled trial in patients positive for antiphospholipid antibodies (ALIWAPAS). Rheumatology (Oxford). 2014;53:275–84.CrossRef

78.

Akhavan PS, Su J, Lou W, Gladman DD, Urowitz MB, Fortin PR. The early protective effect of hydroxychloroquine on the risk of cumulative damage in patients with systemic lupus erythematosus. J Rheumatol. 2013;40:831–41.CrossRefPubMed

79.

79. Bykerk V, Sampalis J, Esdaile JM, choquette D, Senecal JL, Danoff D, et al. A randomized study of the effect of withdrawing hydroxychloroquine sulfate in systemic lupus erythematosus. N. Engl. J. Med. 1991;324:150–4.

80.

Cairoli E, Rebella M, Danese N, Garra V, Borba EF. Hydroxychloroquine reduces low-density lipoprotein cholesterol levels in systemic lupus erythematosus: a longitudinal evaluation of the lipid-lowering effect. Lupus. 2012;21:1178–82.CrossRefPubMed

81.

Cavazzana I, Sala R, Bazzani C, Ceribelli A, Zane C, Cattaneo R, et al. Treatment of lupus skin involvement with quinacrine and hydroxychloroquine. Lupus. 2009;18:735–9.CrossRefPubMed

82.

Ruiz-Irastorza G, Ramos-Casals M, Brito-Zeron P, Khamashta MA. Clinical efficacy and side effects of antimalarials in systemic lupus erythematosus: a systematic review. Ann Rheum Dis. 2010;69:20–8.CrossRefPubMed

83.

Ruiz-Irastorza G, Egurbide MV, Pijoan JI, Garmendia M, Villar I, Martinez-Berriotxoa A, et al. Effect of antimalarials on thrombosis and survival in patients with systemic lupus erythematosus. Lupus. 2006;15:577–83.CrossRefPubMed

84.

Tektonidou MG, Laskari K, Panagiotakos DB, Moutsopoulos HM. Risk factors for thrombosis and primary thrombosis prevention in patients with systemic lupus erythematosus with or without antiphospholipid antibodies. Arthritis Rheum. 2009;61:29–36.CrossRefPubMed

85.

Becker-Merok A, Nossent J. Prevalence, predictors and outcome of vascular damage in systemic lupus erythematosus. Lupus. 2009;18:508–15.CrossRefPubMed

86.

Broder A, Putterman C. Hydroxychloroquine use is associated with lower odds of persistently positive antiphospholipid antibodies and/or lupus anticoagulant in systemic lupus erythematosus. J Rheumatol. 2013;40:30–3.CrossRefPubMedPubMedCentral

87.

Cervera R. CAPS Registry. Lupus. 2012;21:755–7.CrossRefPubMed

Titel: Prevention of Recurrent Thrombosis in Antiphospholipid Syndrome: Different from the General Population?
verfasst von: Kimberly Janet Legault
Amaia Ugarte
Mark Andrew Crowther
Guillermo Ruiz-Irastorza
Publikationsdatum: 01.05.2016
Verlag: Springer US
Erschienen in: Current Rheumatology Reports / Ausgabe 5/2016
Print ISSN: 1523-3774
Elektronische ISSN: 1534-6307
DOI: https://doi.org/10.1007/s11926-016-0573-0

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Echinokokkose medikamentös behandeln oder operieren?

06.05.2024 DCK 2024 Kongressbericht

Die Therapie von Echinokokkosen sollte immer in spezialisierten Zentren erfolgen. Eine symptomlose Echinokokkose kann – egal ob von Hunde- oder Fuchsbandwurm ausgelöst – konservativ erfolgen. Wenn eine Op. nötig ist, kann es sinnvoll sein, vorher Zysten zu leeren und zu desinfizieren.

Umsetzung der POMGAT-Leitlinie läuft

03.05.2024 DCK 2024 Kongressbericht

Seit November 2023 gibt es evidenzbasierte Empfehlungen zum perioperativen Management bei gastrointestinalen Tumoren (POMGAT) auf S3-Niveau. Vieles wird schon entsprechend der Empfehlungen durchgeführt. Wo es im Alltag noch hapert, zeigt eine Umfrage in einem Klinikverbund.

Proximale Humerusfraktur: Auch 100-Jährige operieren?

01.05.2024 DCK 2024 Kongressbericht

Mit dem demographischen Wandel versorgt auch die Chirurgie immer mehr betagte Menschen. Von Entwicklungen wie Fast-Track können auch ältere Menschen profitieren und bei proximaler Humerusfraktur können selbst manche 100-Jährige noch sicher operiert werden.

Die „Zehn Gebote“ des Endokarditis-Managements

30.04.2024 Endokarditis Leitlinie kompakt

Worauf kommt es beim Management von Personen mit infektiöser Endokarditis an? Eine Kardiologin und ein Kardiologe fassen die zehn wichtigsten Punkte der neuen ESC-Leitlinie zusammen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 5/2016

Is There a Role for Diet in the Therapy of Rheumatoid Arthritis?

Rheumatoid Arthritis Pharmacotherapies: Do They Have Anti-Atherosclerotic Activity?

The Role of ANK in Calcium Pyrophosphate Deposition Disease

Fungal Infections and New Biologic Therapies

Pediatric Mixed Connective Tissue Disease