Novel insights into pathogenesis, diagnosis and treatment of antiphospholipid syndrome

Abstract

To provide an update of recent insights into the pathogenesis, diagnosis and treatment of antiphospholipid syndrome (APS) from current literature. β2GPI was recently implicated in the pathogenesis of thrombosis. High titres of anti-β2GPI antibodies are present in patients with triple positivity which highlight its importance. Consensus guidelines have been published to standardise diagnostic assays and once implemented may yield more accurate diagnoses of APS. An 'aPL score' has been formulated to improve the detection and outcomes of patients. New oral anticoagulants, statins and concomitant therapy with warfarin and aspirin have been identified as potential novel therapeutic interventions for thrombotic APS. Advances in the pathogenesis of obstetric APS have occurred, such as the concept of redefining the syndrome as inflammatory and clearer identification of the roles of complement, β2GPI and annexin 5. Independent risk factors for pregnancy failure have been recognised and when combined with clinical and laboratory features may improve patient outcomes. Interventions involving adjusted doses of low molecular weight heparin in combination with aspirin have shown promising results from initial studies. Recent insights into the pathogenesis of APS have unveiled novel areas for treatment intervention. Diagnostic criteria and recommendations have been revised and formulated to provide consensus and standardisation for diagnosis.