Strategies of anticoagulant therapy in various clinical variants of antiphospholipid syndrome

Abstract

Antiphospholipid syndrome (APS) is a systemic autoimmune pathology characterized by thrombotic manifestation associated with antiphospholipid antibodies (aPL) and phospholipid-binding proteins circulation. Long-term anticoagulant therapy is a cornerstone in the treatment and prevention of relapses and manifestations of APS-associated For high-risk APS phenotypes with arterial thrombosis, microthrombosis and triple aPL-positivity VKA use is the only possible option for anticoagulant therapy. The need for constant monitoring of international normalized relations (INR) for achievement and control of target values, intolerance and variability of INR reduce patient compliance in a certain category of patients, which limits their use in some clinical situations. Use of direct oral anticoagulants (DOAC) is an alternative option for anticoagulant therapy. Despite the benefits of using DOAC according to current international recommendations and guidelines their use is limited by the phenotype of APS with venous thrombosis and monoand double aPL-positivity if the patient is unable or unwilling to take VKA due to need for constant INR monitoring. In the obstetric version of APS during gestation, antithrombotic therapy is performed with aspirin and low molecular-weight heparins. The intensity and duration of antithrombotic prophylaxis determining at high-risk APS is a real challenge for the clinician due to the lack of tools for risk stratification and should be carried out depending on the individual characteristics of the patient and the course of APS.