Antiphospholipid syndrome: treatment controversies

Antiphospholipid syndrome (APS) is a well-recognized cause of thrombosis and adverse obstetric events such as early and late miscarriage and pre-eclampsia. Therapeutic studies focused on APS have important limitations regarding their design and/or the characteristics of the patients included, often obtaining contradictory conclusions. Treatment of patients with APS and thrombosis should be individualized. Patients with stroke and recurrent events are candidates for indefinite, high-intensity anticoagulation (with a target international normalized ratio [INR] of 3.0–4.0). Those with nonlife-threatening venous thrombotic events could receive anticoagulation at the standard level (target INR 2.0–3.0). Likewise, the optimal management of miscarriage in APS is not well established. While the combination of aspirin–low molecular weight heparin is generally recommended, aspirin alone may have a role in treating women with early pregnancy losses only. In all settings, adequate peripartum thromboprophylaxis should...