St. Joseph's Hospital, Hamilton, Ontario, Canada.
Crit Care Med. 2010 Feb;38(2 Suppl):S51-6. doi: 10.1097/CCM.0b013e3181c9e363.
The antiphospholipid syndrome is defined by the presence of antiphospholipid antibodies in patients with recurrent venous or arterial thromboembolism or pregnancy morbidity. Antithrombotic therapies are the mainstay of treatment to reduce the risk of recurrent thromboembolism. Among patients with antiphospholipid antibodies, the absolute risk of new thrombosis developing is low in healthy patients without previous thrombotic events. However, the risk of recurrent thrombosis appears to be high in patients with a history of arterial or venous thrombosis. Compared with placebo or untreated control, anticoagulation with warfarin administered to achieve an international normalized ratio of 2.0 to 3.0 probably reduces the risk of recurrence of thrombotic events. Aspirin and moderate-intensity warfarin appear equally effective for preventing recurrent stroke in patients with a single positive antiphospholipid antibody test result and previous stroke. It is unknown how best to prevent first stroke in patients found to be persistently positive for the antiphospholipid syndrome. The catastrophic variant of the antiphospholipid syndrome is a condition characterized by multiple vascular occlusive events, usually affecting small vessels and evolving over a short period of time. This condition has a very high mortality rate. First-line treatment with therapeutic anticoagulation, corticosteroids, plasma exchange, and intravenous immunoglobulin seems to be effective in reducing mortality and risk of catastrophic thrombotic events in these patients. In conclusion, moderate-intensity warfarin is effective for preventing recurrent thrombotic events in patients with venous thrombosis. Aspirin appears to be as effective as moderate-intensity warfarin for preventing recurrent stroke in patients with previous stroke and a single positive test result for antiphospholipid antibody. The optimal treatment of other clinical manifestations of antiphospholipid syndrome needs to be addressed in well-designed prospective studies.
抗磷脂综合征的定义为存在抗磷脂抗体的患者伴有复发性静脉或动脉血栓栓塞或妊娠并发症。抗血栓治疗是降低复发性血栓栓塞风险的主要治疗方法。在存在抗磷脂抗体的患者中，无先前血栓事件的健康患者中新血栓形成的绝对风险较低。然而，有动脉或静脉血栓形成病史的患者似乎有较高的复发性血栓形成风险。与安慰剂或未治疗对照相比，华法林抗凝治疗使国际标准化比值达到 2.0 至 3.0 可能降低血栓事件复发的风险。阿司匹林和中等强度华法林似乎对预防有单一抗磷脂抗体检测结果阳性和先前卒中的患者复发性卒中同样有效。尚不清楚如何最好地预防持续存在抗磷脂综合征的患者首次卒中。抗磷脂综合征的灾难性变异是一种以多发血管闭塞事件为特征的疾病，通常影响小血管并在短时间内进展。这种情况的死亡率非常高。一线治疗采用治疗性抗凝、皮质激素、血浆置换和静脉注射免疫球蛋白似乎可有效降低这些患者的死亡率和灾难性血栓事件风险。总之，中等强度华法林可有效预防静脉血栓形成患者的复发性血栓事件。阿司匹林似乎与中等强度华法林一样有效，可预防有先前卒中和单一抗磷脂抗体检测结果阳性的患者复发性卒中。需要在精心设计的前瞻性研究中解决抗磷脂综合征其他临床表现的最佳治疗方法。
