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Prophylaxis of the antiphospholipid syndrome: a consensus report

Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico DF, Mexico, das{at}innsz.mx

M C Boffa

Department of Internal Medicine, Hôpital Pitié-Salpêtrière, Paris, France

W Branch

Department of Obstetrics and Gynecology, University of Utah Health Science Center, Salt Lake City, Utah, USA

R Cervera

Department of Autoirmmune Diseases, Institut Clínic d’Infeccions i Immunologia, Hospital Clínic, Barcelona, Catalonia, Spain

A Gharavi

Morehouse School of Medicine, Atlanta, Georgia, USA

M Khamashta

Lupus Research Unit, Rayne Institute, St Thomas’ Hospital, London, UK

Y Shoenfeld

Research Center for Autoimmune Diseases, Intern. Med. ‘B’, Sheba Medical Center, Tel-Hashomer, Israel

W Wilson

Department of Medicine, Section of Rheumatology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA

R Roubey

Division of Rheumatology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA

Hypothetical circumstances that may require prophylaxis for a potential antiphospholipid syndrome (primary prophylaxis), or in some instances when there already had been some manifestations of the syndrome (secondary prophylaxis), were presented to a panel of experts for their consideration on potential prophylactic intervention. These were subsequently presented to the participants in the First InternationalConsensuson Treatment of the AntiphospholipidSyndrome. In most instances there was consensus in adding low dose aspirin, an exception being aspirin allergy when other antiaggregants could be used in nonpregnant subjects. General measures to prevent thrombosis and other vaso-protective actions should also be provided. Higher risk of fetal loss or thrombosis called for anticoagulation with coumadin in nonpregnant subjects or subcutaneous low molecular weight heparin in pregnant ones. When indicated, prophylaxis of the antiphospholipid syndrome should be provided in systemic lupus erythematosus patients who are being treated for their disease. In no instanceshould corticosteroidsor immunosuppresantsbe given as prophylacticof an antiphospholipid syndrome.

Key Words: anti-ß-2-glycoprotein • anticoagulation • antiphospholipid antibodies • low-dose aspirin • pregnancy loss • systemic lupus erythematosus • thrombosis prevention

Lupus, Vol. 12, No. 7, 499-503 (2003)
DOI: 10.1191/0961203303lu388oa


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