Eventos trombóticos en pacientes con síndrome antifosfolípido y su manejo profiláctico.
Palabras clave:
Síndrome antifosfolípido, Trombosis, Anticoagulantes orales directos, Warfarina, Hidroxicloroquina, Omega 3, Antiagregantes plaquetariosResumen
El síndrome antifosfolípido (SAF) es una condición clínica cuya principal forma de presentación es la trombosis de diversos lechos vasculares, llevando a múltiples complicaciones que representan una amenaza a la vida de los pacientes. Por lo anterior se tiene como objetivo de esta revisión dar a conocer las recomendaciones más actuales sobre el manejo del síndrome, además de recalcar la existencia de alternativas terapéuticas distintas a los inhibidores de la vitamina K. La exploración de múltiples guías internacionales en cuanto al manejo del SAF permitió establecer que la Warfarina sigue siendo el pilar de manejo para las manifestaciones trombóticas de la enfermedad y que el uso de DOACs no se recomienda para el manejo debido al riesgo de trombosis recurrente asociada a su uso en pacientes con SAF. Se requiere de más ensayos clínicos e investigación para recomendar de forma segura el uso de terapias distintas a Warfarina en pacientes con SAF.
Descargas
Referencias
Radin M, Foddai SG, Barinotti A, Cecchi I, Rubini E, Sciascia S, et al. Reducing the diagnostic delay in Antiphospholipid Syndrome over time: a real world observation. Orphanet J Rare Dis. (1):280. DOI: 10.1186/s13023-021-01906-1.
Pastori D, Menichelli D, Cammisotto V, Pignatelli P. Use of Direct Oral Anticoagulants in Patients With Antiphospholipid Syndrome: A Systematic Review and Comparison of the International Guidelines. Front Cardiovasc Med. 8:715878. DOI: 10.3389/fcvm.2021.715878.
Mezhov V, Segan JD, Tran H, Cicuttini FM. Antiphospholipid syndrome: a clinical review. Med J ;211(4):184-188. DOI: 10.5694/mja2.50262
Rodziewicz M, D’Cruz DP. An update on the management of antiphospholipid syndrome. Ther Adv Musculoskelet Dis; 12:1759720X20910855. DOI: 10.1177/1759720X20910855.
Restrepo R, Velásquez C, Muñoz C, Pinto P, Márquez J, Rodríguez L, et al. Uso de inhibidores directos del factor Xa en síndrome antifosfolípido: una serie de 7 casos. Rev.Colomb.Reumatol. 25(1): 16-21. DOI: 10.1016/j.rcreu.2017.07.004
Cohen, H, Efthymiou, M, Isenberg, DA. Use of direct oral anticoagulants in antiphospholipid syndrome. J Thromb Haemost 2018; 16: 1028-1039.
Khodashahi M, Rezaieyazdi Z, Sahebari M. Comparison of the Therapeutic Effects of Rivaroxaban Versus Warfarin in Antiphospholipid Syndrome: A Systematic Review. Arch Rheumatol. ;35(1):107-116. DOI: 10.5606/ArchRheumatol.2020.7375.
Chighizola CB, Raimondo MG, Meroni PL. Management of Thrombotic Antiphospholipid Syndrome. Semin Thromb Hemost. 2018 Jul;44(5):419-426. DOI: 10.1055/s-0036-1597282.
Garcia D, Erkan D. Diagnosis and management of the antiphospholipid syndrome. N Engl J Med. 2018;378(21):2010-21.
Fujieda Y, Amengual O. New insights into the pathogenic mechanisms and treatment of arterial thrombosis in antiphospholipid syndrome. Eur J Rheumatol. 8(2):93-9. DOI: 10.5152/eurjrheum.2020.20058
Aguiar CL, Erkan D. Catastrophic antiphospholipid syndrome: how to diagnose a rare but highly fatal disease. Ther Adv Musculoskelet Dis. 2013 Dec;5(6):305-14. DOI: 10.1177/1759720X13502919
Collict M, Sciberras W, Mercieca C, Thake J. Catastrophic antiphospholipid syndrome in pregnancy: a life-threatening condition. BMJ Case Rep. 12(9):e230863. DOI: 10.1136/bcr-2019-230863.
Cervera R, Piette JC, Font J, Khamashta MA, Shoenfeld Y, Camps MT,et al; Euro-Phospholipid Project Group. Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. Arthritis Rheum.;46(4):1019-27. DOI: 10.1002/art.10187.
Rodríguez-Pintó I, Espinosa G, Erkan D, Shoenfeld Y, Cervera R; CAPS Registry Project Group. The effect of triple therapy on the mortality of catastrophic anti-phospholipid syndrome patients. Rheumatology (Oxford).57(7):1264-1270. DOI: 10.1093/rheumatology/key082.
Antovic A, Sennström M, Bremme K, Svenungsson E. Obstetric antiphospholipid syndrome. Lupus Sci Med. 5(1):e000197. DOI: 10.1136/lupus-2016-000197.
Lefèvre G, Lambert M, Bacri JL, Dubucquoi S, Quemeneur T, Caron C, et al. Thrombotic events during long-term follow-up of obstetric antiphospholipid syndrome patients. Lupus. 20(8):861-5. DOI: 10.1177/0961203310397080.
de Jesús GR, Sciascia S, Andrade D, Barbhaiya M, Tektonidou M, Banzato A, et al. Factors associated with first thrombosis in patients presenting with obstetric antiphospholipid syndrome (APS) in the APS Alliance for Clinical Trials and International Networking Clinical Database and Repository: a retrospective study. BJOG. 126(5):656-661. DOI: 10.1111/1471-0528.15469.
Drozidnsky G, Hadar E, Shmueli A, Gabbay-Benziv R, Shiber S. Obstetric antiphospholipid syndrome and long term arterial thrombosis risk. J Thromb Thrombolysis. 2017;44(3):371-375
Gris J-C, Bouvier S, Molinari N, Galanaud J-P, Cochery-Nouvellon E, Mercier E, et al. Comparative incidence of a first thrombotic event in purely obstetric antiphospholipid syndrome with pregnancy loss: the NOH-APS observational study. Blood. 2012;119(11):2624-32.
Martinez-Zamora MA, Peralta S, Creus M, Tassies D, Reverter JC, Espinosa G, et al. Risk of thromboembolic events after recurrent spontaneous abortion in antiphospholipid syndrome: a case-control study. Ann Rheum Dis. 2012;71(1):61-6.
Erkan D, Harrison MJ, Levy R, Peterson M, Petri M, Sammaritano L, et al. Aspirin for primary thrombosis prevention in the antiphospholipid syndrome: A randomized, double-blind, placebo-controlled trial in asymptomatic antiphospholipid antibody-positive individuals. Arthritis Rheum. 2007;56(7):2382-91.
Zuo Y, Shi H, Li C, Knight JS. Antiphospholipid syndrome: a clinical perspective. Chin Med J (Engl). 133(8):929-940. DOI: 10.1097/CM9.0000000000000705.
Algahtani FH, AlQahtany FS, ElGohary G, Alsharidi A, Sayeeda A, AlArfaj H, et al. The clinical and laboratory manifestations profile of antiphospholipid syndrome among Saudi Arabia population: Examining the applicability of Sapporo criteria. Saudi J Biol Sci.27(9):2425-2430. DOI: 10.1016/j.sjbs.2020.05.037.
Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006;4:295-306.
Tektonidou MG, Andreoli L, Limper M, Amoura Z, Cervera R, Costedoat-Chalumeau N, et al. EULAR recommendations for the management of antiphospholipid syndrome in adults. Ann Rheum Dis. 78(10):1296-1304. DOI: 10.1136/annrheumdis-2019-215213. Epub 2019 May 15.
Ghembaza A, Saadoun D. Management of Antiphospholipid Syndrome. Biomedicines. 8(11):508. DOI: 10.3390/biomedicines8110508.
Pengo V, Denas G, Zoppellaro G, Jose SP, Hoxha A, Ruffatti A, et al. Rivaroxaban vs warfarin in high-risk patients with antiphospholipid syndrome. Blood. 132(13):1365-1371. DOI: 10.1182/blood-2018-04-848333.
Pengo V, Hoxha A, Andreoli L, Tincani A, Silvestri E, Prisco D. Trial of Rivaroxaban in AntiPhospholipid Syndrome (TRAPS): Two-year outcomes after the study closure. J Thromb Haemost. 219(2):531-535. DOI: 10.1111/jth.15158.
Cohen H, Hunt BJ, Efthymiou M, Arachchillage DR, Mackie IJ, Clawson S. Rivaroxaban versus warfarin to treat patients with thrombotic antiphospholipid syndrome, with or without systemic lupus erythematosus (RAPS): a randomised, controlled, open-label, phase 2/3, non-inferiority trial. Lancet Haematol. 3(9):e426-36. DOI: 10.1016/S2352-3026(16)30079-5.
Arachchillage DRJ, Laffan M. Pathogenesis and management of antiphospholipid syndrome. Br J Haematol. 178(2):181-195. DOI: 10.1111/bjh.14632
Dufrost V, Risse J, Reshetnyak T, Satybaldyeva M, Du Y, Yan X et al. Increased risk of thrombosis in antiphospholipid syndrome patients treated with direct oral anticoagulants. Results from an international patient-level data meta-analysis. Autoimmunity Reviews 17 (2018) 1011-1021. doi.org/10.1016/j.autrev.2018.04.009
Woller S, Stevens S, Kaplan D, Wang T, Branch D, Groat D et al. Apixaban compared with warfarin to prevent thrombosis un thrombotic antiphospholipid syndrome: a randomized trial. Blood Adv. ;bloodadvances.2021005808. DOI: 10.1182/bloodadvances.2021005808.
Fazili M, Stevens SM, Woller SC. Direct oral anticoagulants in antiphospholipid syndrome with venous thromboembolism: Impact of the European Medicines Agency guidance. Res Pract Thromb Haemost.4(1):9-12. DOI: 10.1002/rth2.12287.
Sayar Z, Moll R, Isenberg D, Cohen H. Thrombotic antiphospholipid syndrome: A practical guide to diagnosis and management. Thromb Res. 198:213-221. DOI: 10.1016/j.thromres.2020.10.010.
Cohen H, Cuadrado MJ, Erkan D, Duarte-Garcia A, Isenberg DA, Knight JS, et al. 16th International Congress on Antiphospholipid Antibodies Task Force Report on Antiphospholipid Syndrome Treatment Trends. Lupus. 29(12):1571-1593. DOI: 10.1177/0961203320950461.
Zuily S, Cohen H, Isenberg D, Woller SC, Crowther M, Dufrost V. Use of direct oral anticoagulants in patients with thrombotic antiphospholipid syndrome: Guidance from the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis. J Thromb Haemost.18(9):2126-2137. DOI: 10.1111/jth.14935.
Arachchillage DRJ, Gomez K, Alikhan R, Anderson JAM, Lester W, Laffan M; British Society for Haematology Haemostasis and Thrombosis Taskforce. Addendum to British Society for Haematology Guidelines on Investigation and Management of Antiphospholipid syndrome, 2012 (Br. J. Haematol. 2012; 157: 47-58): use of direct acting oral anticoagulants. Br J Haematol. 189(2):212-215. DOI: 10.1111/bjh.16308.
Devaux CA, Camoin-Jau L, Mege JL, Raoult D. Can hydroxychloroquine be protective against COVID-19-associated thrombotic events ? J Microbiol Immunol Infect. 54(1):37-45. DOI: 10.1016/j.jmii.2020.12.010
Schrezenmeier E, Dörner T. Mechanisms of action of hydroxychloroquine and chloroquine: implications for rheumatology. Nat Rev Rheumatol. 16(3):155-166. DOI: 10.1038/s41584-020-0372-x
Nosal R., Jancinova V., Petrikova M. Chloroquine inhibits stimulates platelets at the arachidonic acid pathway. Thromb Res. 1995;77:531-542.
Rahman R., Murthi P., Singh H., Gurusinghe S., Mockler J.C., Lim R. The effects of hydroxychloroquine on endothelial dysfunction. Pregnancy Hypertens. 2016;6:259-262.
Li R., Lin H., Ye Y., Xiao Y., Xu S., Wang J. Attenuation of antimalarial agent hydroxychloroquine on TNF-alpha-induced endothelial inflammation. Int Immunopharm. 2018;63:261-269.
Rand JH, Wu XX, Quinn AS, Taatjes DJ. The annexin A5-mediated pathogenic mechanism in the antiphospholipid syndrome: role in pregnancy losses and thrombosis. Lupus. 19(4):460-9. DOI: 10.1177/0961203310361485.
Nuri, E, Taraborelli, M, Andreoli, L, et al. Long-term use of hydroxychloroquine reduces antiphospholipid antibodies levels in patients with primary antiphospholipid syndrome. Immunol Res 2017; 65: 17-24.
Kravvariti, E, Koutsogianni, A, Samoli, E, Sfikakis, PP, Tektonidou, MG. The effect of hydroxychloroquine on thrombosis prevention and antiphospholipid antibody levels in primary antiphospholipid syndrome: a pilot open label randomized prospective study. Autoimmun Rev 2020; 19: 102491.
Kuszewski JC, Wong RHX, Howe PRC. Effects of Long-Chain Omega-3 Polyunsaturated Fatty Acids on Endothelial Vasodilator Function and Cognition-Are They Interrelated? Nutrients. ;9(5):487. DOI: 10.3390/nu9050487.
Man AWC, Li H, Xia N. Impact of Lifestyles (Diet and Exercise) on Vascular Health: Oxidative Stress and Endothelial Function. Oxid Med Cell Longev. 2020:1496462. DOI: 10.1155/2020/1496462.
Felau SM, Sales LP, Solis MY, Hayashi AP, Roschel H, Sá-Pinto AL, et al. Omega-3 Fatty Acid Supplementation Improves Endothelial Function in Primary Antiphospholipid Syndrome: A Small-Scale Randomized Double-Blind Placebo-Controlled Trial. Front Immunol. 9:336. DOI: 10.3389/fimmu.2018.00336.
Kwak JH, Paik JK, Kim HI, Kim OY, Shin DY, Kim HJ, et al. Dietary treatment with rice containing resistant starch improves markers of endothelial function with reduction of postprandial blood glucose and oxidative stress in patients with prediabetes or newly diagnosed type 2 diabetes. Atherosclerosis. 224(2):457-64. DOI: 10.1016/j.atherosclerosis.2012.08.003
Flammer AJ, Martin EA, Gössl M, Widmer RJ, Lennon RJ, Sexton JA, et al. Polyphenol-rich cranberry juice has a neutral effect on endothelial function but decreases the fraction of osteocalcin-expressing endothelial progenitor cells. Eur J Nutr. 52(1):289-96. DOI: 10.1007/s00394-012-0334-4.
Maalouly G, Ward C, Smayra V, Saliba Y, Aftimos G, Haddad F, et al. Fish oil attenuates neurologic severity of antiphospholipid syndrome in a mice experimental model. Nutr Neurosci. 20(10):563-570. DOI: 10.1080/1028415X.2016.1206165
Singal AK, Karthikeyan G. Aspirin for primary prevention: Is this the end of the road? Indian Heart J. 71(2):113-117. DOI: 10.1016/j.ihj.2019.04.001.
Goli RR, Contractor MM, Nathan A, Tuteja S, Kobayashi T, Giri J. Antiplatelet Therapy for Secondary Prevention of Vascular Disease Complications. Curr Atheroscler Rep. 19(12):56. DOI: 10.1007/s11883-017-0698-2.
Atallah A, Lecarpentier E, Goffinet F, Doret-Dion M, Gaucherand P, Tsatsaris V. Aspirin for Prevention of Preeclampsia. Drugs. 77(17):1819-1831. DOI: 10.1007/s40265-017-0823-0.
Iqbal AM, Lopez RA, Hai O. Antiplatelet Medications. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan
Bala MM, Celinska-Lowenhoff M, Szot W, Padjas A, Kaczmarczyk M, Swierz MJ, et al. Antiplatelet and anticoagulant agents for secondary prevention of stroke and other thromboembolic events in people with antiphospholipid syndrome. Cochrane Database Syst Rev.10(10):CD012169. DOI: 10.1002/14651858.CD012169.pub2. Update in: Cochrane Database Syst Rev. 2020 Oct 12;10:CD012169.
Descargas
Publicado
Número
Sección
Licencia
Derechos de autor 2023 Salutem Scientia Spiritus
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.
La Revista Salutem Scientia Spiritus usa la licencia Creative Commons de Atribución – No comercial – Sin derivar: Los textos de la revista son posibles de ser descargados en versión PDF siempre que sea reconocida la autoría y el texto no tenga modificaciones de ningún tipo.
