Mendes George Nilton Nunes, Morais Alessandra Braga Cruz Guedes de, Gioia Laura Catherine, Jacquin Grégory, Poppe Alexandre Y, Soga Felipe Hideki, Andrade João Brainer Clares de
Université de Montréal, Centre Hospitalier, Programme de Santé Neurovasculaire, Montréal Québec, Canada.
Université de Montréal, Centre Hospitalier, Centre de Recherche, Axe Neurosciences, Montréal Québec, Canada.
Arq Neuropsiquiatr. 2024 Dec;82(12):1-7. doi: 10.1055/s-0044-1793932. Epub 2024 Dec 10.
Antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by thrombosis, pregnancy complications, and other nonthrombotic manifestations in the presence of antiphospholipid antibodies. Neurovascular complications, including ischemic stroke, cerebral venous thrombosis and cognitive impairment, pose significant challenges in management.
To comprehensively review relevant and updated clinical aspects of neurovascular manifestations of APS.
We conducted a narrative review using the PubMed, EMBASE, and Cochrane Library databases with medical terms related to APS and its neurovascular manifestations. English-language studies, published between January 1, 2015, and March 2024, were included. Key publications outside this timeframe were also considered. Studies with higher levels of evidence, such as randomized controlled trials and meta-analyses, were prioritized for inclusion.
Stroke is a prevalent complication in APS, with arterial thrombosis being a predominant mechanism. Despite recent trials, direct oral anticoagulants (DOACs) have not shown superiority over vitamin K antagonists (VKAs) for secondary prevention in this population. Cerebral venous thrombosis (CVT), although rare, can also occur in APS, and while DOACs have shown promise as a treatment in a general population, caution is warranted due to potential harm. Cognitive impairment affects a considerable proportion of APS patients, with thrombotic and nonthrombotic mechanisms contributing to its pathophysiology. Future research should focus on optimal management strategies for cognitive impairment and the efficacy of anticoagulation and immunosuppression.
Understanding the complex interplay of neurovascular manifestations in APS is essential for guiding clinical decisions and improving patient outcomes. Despite advancements, some challenges remain in establishing effective preventive and treatment measures, highlighting the need for further research in this field.
抗磷脂综合征（APS）是一种全身性自身免疫性疾病，其特征为在存在抗磷脂抗体的情况下出现血栓形成、妊娠并发症及其他非血栓形成表现。神经血管并发症，包括缺血性卒中、脑静脉血栓形成和认知障碍，给治疗带来了重大挑战。
全面综述APS神经血管表现的相关最新临床情况。
我们使用PubMed、EMBASE和Cochrane图书馆数据库，对与APS及其神经血管表现相关的医学术语进行叙述性综述。纳入2015年1月1日至2024年3月期间发表的英文研究。也考虑了该时间范围之外的关键出版物。优先纳入证据水平较高的研究，如随机对照试验和荟萃分析。
卒中是APS中常见的并发症，动脉血栓形成是主要机制。尽管近期有试验，但在该人群的二级预防中，直接口服抗凝剂（DOACs）并未显示出优于维生素K拮抗剂（VKAs）。脑静脉血栓形成（CVT）虽然罕见，但也可发生在APS中，虽然DOACs在一般人群中显示出作为治疗方法的前景，但由于潜在危害，仍需谨慎使用。认知障碍影响相当一部分APS患者，血栓形成和非血栓形成机制均参与其病理生理过程。未来的研究应聚焦于认知障碍的最佳管理策略以及抗凝和免疫抑制的疗效。
了解APS中神经血管表现的复杂相互作用对于指导临床决策和改善患者预后至关重要。尽管取得了进展，但在建立有效的预防和治疗措施方面仍存在一些挑战，这凸显了该领域进一步研究的必要性。
