Danowski Adriana, Rego Jozelia, Kakehasi Adriana M, Funke Andreas, Carvalho Jozelio Freire de, Lima Isabella V S, Souza Alexandre Wagner Silva de, Levy Roger A
Hospital Federal dos Servidores do Estado, Rio de Janeiro, RJ, Brazil.
Rev Bras Reumatol. 2013 Apr;53(2):184-92.
The antiphospholipid syndrome (APS) is a systemic autoimmune disease characterized by arterial and venous thrombosis, gestational morbidity and presence of elevated and persistently positive serum titers of antiphospholipid antibodies. The treatment of APS is still controversial, because any therapeutic decision potentially faces the risk of an insufficient or excessive antithrombotic coverage associated with anticoagulation and its major adverse effects. This guideline was elaborated from nine relevant clinical questions related to the treatment of APS by the Committee of Vasculopathies of the Brazilian Society of Rheumatology. Thus, this study aimed at establishing a guideline that included the most relevant and controversial questions in APS treatment, based on the best scientific evidence available. The questions were structured by use of the PICO (patient, intervention or indicator, comparison and outcome) process, enabling the generation of search strategies for evidence in the major primary scientific databases (MEDLINE/PubMed, Embase, Lilacs, Scielo, Cochrane Library, Premedline via OVID). A manual search for evidence and theses was also conducted (BDTD and IBICT). The evidence retrieved was selected based on critical assessment by using discriminatory instruments (scores) according to the category of the therapeutic question (JADAD scale for randomized clinical trials and Newcastle-Ottawa scale for non-randomized studies). After defining the potential studies to support the recommendations, they were selected according to level of evidence and grade of recommendation, according to the Oxford classification.
抗磷脂综合征（APS）是一种全身性自身免疫性疾病，其特征为动脉和静脉血栓形成、妊娠并发症以及抗磷脂抗体血清滴度升高且持续呈阳性。APS的治疗仍存在争议，因为任何治疗决策都可能面临与抗凝相关的抗血栓覆盖不足或过度的风险及其主要不良反应。本指南由巴西风湿病学会血管病委员会针对与APS治疗相关的九个临床问题制定。因此，本研究旨在基于现有最佳科学证据，制定一份涵盖APS治疗中最相关和最具争议问题的指南。这些问题通过使用PICO（患者、干预措施或指标、对照和结局）流程构建，从而能够为主要的原始科学数据库（MEDLINE/PubMed、Embase、Lilacs、Scielo、Cochrane图书馆、通过OVID的预医学线）生成证据检索策略。还进行了手动证据检索和论文检索（BDTD和IBICT）。根据治疗问题的类别，使用鉴别工具（评分）进行批判性评估，从而筛选出检索到的证据（随机临床试验采用JADAD量表，非随机研究采用纽卡斯尔-渥太华量表）。在确定支持这些建议的潜在研究后，根据牛津分类法，按照证据水平和推荐等级对其进行选择。
