PT  - JOURNAL ARTICLE
AU  - Maria G Tektonidou
AU  - Laura Andreoli
AU  - Marteen Limper
AU  - Zahir Amoura
AU  - Ricard Cervera
AU  - Nathalie Costedoat-Chalumeau
AU  - Maria Jose Cuadrado
AU  - Thomas Dörner
AU  - Raquel Ferrer-Oliveras
AU  - Karen Hambly
AU  - Munther A Khamashta
AU  - Judith King
AU  - Francesca Marchiori
AU  - Pier Luigi Meroni
AU  - Marta Mosca
AU  - Vittorio Pengo
AU  - Luigi Raio
AU  - Guillermo Ruiz-Irastorza
AU  - Yehuda Shoenfeld
AU  - Ljudmila Stojanovich
AU  - Elisabet Svenungsson
AU  - Denis Wahl
AU  - Angela Tincani
AU  - Michael M Ward
TI  - EULAR recommendations for the management of antiphospholipid syndrome in adults
AID  - 10.1136/annrheumdis-2019-215213
DP  - 2019 May 15
TA  - Annals of the Rheumatic Diseases
PG  - annrheumdis-2019-215213
4099  - http://ard.bmj.com/content/early/2019/06/14/annrheumdis-2019-215213.short
4100  - http://ard.bmj.com/content/early/2019/06/14/annrheumdis-2019-215213.full
AB  - The objective was to develop evidence-based recommendations for the management of antiphospholipid syndrome (APS) in adults. Based on evidence from a systematic literature review and expert opinion, overarching principles and recommendations were formulated and voted. High-risk antiphospholipid antibody (aPL) profile is associated with greater risk for thrombotic and obstetric APS. Risk modification includes screening for and management of cardiovascular and venous thrombosis risk factors, patient education about treatment adherence, and lifestyle counselling. Low-dose aspirin (LDA) is recommended for asymptomatic aPL carriers, patients with systemic lupus erythematosus without prior thrombotic or obstetric APS, and non-pregnant women with a history of obstetric APS only, all with high-risk aPL profiles. Patients with APS and first unprovoked venous thrombosis should receive long-term treatment with vitamin K antagonists (VKA) with a target international normalised ratio (INR) of 2–3. In patients with APS with first arterial thrombosis, treatment with VKA with INR 2–3 or INR 3–4 is recommended, considering the individual’s bleeding/thrombosis risk. Rivaroxaban should not be used in patients with APS with triple aPL positivity. For patients with recurrent arterial or venous thrombosis despite adequate treatment, addition of LDA, increase of INR target to 3–4 or switch to low molecular weight heparin may be considered. In women with prior obstetric APS, combination treatment with LDA and prophylactic dosage heparin during pregnancy is recommended. In patients with recurrent pregnancy complications, increase of heparin to therapeutic dose, addition of hydroxychloroquine or addition of low-dose prednisolone in the first trimester may be considered. These recommendations aim to guide treatment in adults with APS. High-quality evidence is limited, indicating a need for more research.