Department of Autoimmune Diseases, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain.
Faculty of Medicine, University of Porto, Porto, Portugal.
Expert Rev Hematol. 2021 May;14(5):457-466. doi: 10.1080/17474086.2021.1923474. Epub 2021 May 16.
: Some patients with positive antiphospholipid antibodies (aPL) have not been included in randomized clinical trials or observational registries and, therefore, information on their risk of obstetric or thrombotic recurrence and optimal treatment is scarce.: In the present review, the existing evidence regarding the management of two laboratory scenarios not covered by the guidelines is presented: (1) patients with antiphospholipid syndrome (APS) clinical manifestations and aPL positivity not fulfilling APS laboratory criteria, and (2) the possibility of discontinuing anticoagulation in APS patients whose aPL become persistently negative.: Growing evidence suggests a role for low titers and 'non-criteria' aPL, especially in obstetric APS. Treatment is not formally recommended but might be considered according to the individual's risk profile. Regarding the question of whether or not to discontinue anticoagulants after the 'spontaneous' disappearance of aPL, there is no definite answer. Retrospective studies seem to suggest that withdrawal of anticoagulation could be safe in certain patients with APS, especially in those with a first provoked venous thrombosis and whose aPL became persistently negative during follow-up. Still, before the withdrawal can be recommended in routine clinical practice, multicenter and prospective studies are required to validate this hypothesis.
一些抗磷脂抗体（aPL）阳性的患者并未被纳入随机临床试验或观察性登记研究中，因此，关于他们发生产科或血栓复发的风险以及最佳治疗方法的信息非常有限。在本次综述中，提出了现有关于两个未被指南涵盖的实验室情况的管理证据：（1）具有抗磷脂综合征（APS）临床表现且 aPL 阳性但不符合 APS 实验室标准的患者；（2）APS 患者的 aPL 持续转为阴性时是否可以停止抗凝治疗。越来越多的证据表明低滴度和“非标准”aPL 具有一定作用，尤其是在产科 APS 中。虽然没有正式推荐治疗方法，但可以根据个体的风险状况进行考虑。至于在 aPL“自发”消失后是否停止抗凝剂的问题，尚无明确答案。回顾性研究似乎表明，对于某些 APS 患者，尤其是那些初次发生静脉血栓形成且 aPL 在随访期间持续转为阴性的患者，停止抗凝治疗可能是安全的。然而，在推荐常规临床实践中停止抗凝治疗之前，需要进行多中心和前瞻性研究来验证这一假设。
