Saadoun D, Piette J-C, Wahl D, Costedoat-Chalumeau N
Service de médecine interne, centre de référence national pour le lupus et le syndrome des antiphospholipides, CHU Pitié-Salpêtrière, AP-HP, université Pierre-et-Marie-Curie-Paris-6, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
Rev Med Interne. 2012 Apr;33(4):217-22. doi: 10.1016/j.revmed.2012.01.007. Epub 2012 Feb 21.
The prevention of thrombosis in the antiphospholipid syndrome (APS) remains controversial. The purpose of this review is to provide updated recommendations. There is evidence that patients at risk of thrombosis are those with "a pattern of high risk antiphospholipid antibodies (aPL)" (presence of a lupus anticoagulant [LA], association of several aPL, or persistent aCL at a medium or high level), or those with associated systemic lupus erythematosus (SLE). The prescription of aspirin in primary prevention is recommended in SLE patients with positive LA or persistent aCL at a significant level. Secondary prevention is based on a very prolonged anticoagulation. An INR around 2.5 seems to be sufficient in patients with venous APS. In case of arterial events, the attitude is debated. We propose to maintain a target INR between 3 and 3.5. The possible occurrence of relapse despite anticoagulation in the therapeutic target may lead to the addition of aspirin. The development of new anti-thrombotic agents might change the management of APS in the coming years.
抗磷脂综合征（APS）中血栓形成的预防仍存在争议。本综述的目的是提供最新的建议。有证据表明，有血栓形成风险的患者是那些具有“高危抗磷脂抗体（aPL）模式”（存在狼疮抗凝物[LA]、几种aPL的联合或中高水平的持续性抗心磷脂抗体[aCL]）的患者，或患有相关系统性红斑狼疮（SLE）的患者。对于LA阳性或有显著水平的持续性aCL的SLE患者，建议在一级预防中使用阿司匹林。二级预防基于非常长时间的抗凝治疗。对于静脉型APS患者，国际标准化比值（INR）约为2.5似乎就足够了。对于动脉事件，治疗方案存在争议。我们建议将目标INR维持在3至3.5之间。尽管在治疗目标范围内进行了抗凝治疗，但仍可能出现复发，这可能导致加用阿司匹林。未来几年，新型抗血栓药物的研发可能会改变APS的治疗管理。
