Current Treatment Options in Rheumatology | 2019
Management of Antiphospholipid Syndrome in Patients with Systemic Lupus Erythematosus
Abstract
To provide an approach to primary and secondary prevention of thrombotic events and obstetric complications in patients with antiphospholipid antibodies (aPL) with or without antiphospholipid syndrome (APS), particularly in association with systemic lupus erythematosus (SLE). The available evidence would suggest that direct oral anticoagulants are inferior to warfarin at prevention of recurrent thrombosis, particularly in patients with a history of arterial thrombosis or triple aPL positivity. Novel therapies currently being considered for APS include eculizumab, and B cell inhibitors, which may have a role in refractory or resistant APS. Patients should be risk-stratified for risk of thromboembolism, and traditional cardiovascular risk factors addressed. Primary prophylaxis with aspirin should be considered in patients with SLE and aPL. Secondary prevention for APS is with warfarin with an INR of 2.0–3.0. Pregnant SLE patients with aPL/APS are managed with aspirin and heparin.