EULAR Publishes List of 12 Recommendations for Treating Antiphospholipid Syndrome

According to a publication from Medicine Matters, a 12-person task force organized by the European League Against Rheumatism (EULAR) has released a set of 12 recommendations to improve quality of care for adult patients with antiphospholipid syndrome.

About Antiphospholipid Syndrome

Antiphospholipid syndrome (APS, or sometimes Hughes Syndrome) is an autoimmune disorder that makes the blood much more likely to form dangerous clots.

Autoimmune disorders are caused by malfunctioning immune systems that mistakenly target healthy tissues and organs. In the case of APS, the immune system creates antiphospholipid antibodies (aPL) – mutant antibodies that attach to fat molecules (phospholipids) in the blood and significantly increase the risk of clotting.

Diagnosing the condition definitively requires a blood test, since symptoms are similar to those of multiple sclerosis.

EULAR’s Recommendations

The EULAR’s recommendations all adhere to the same three overarching principles meant to guide treatment

Guiding Principles

  • The importance of identification of present factors associated with elevated risk for thrombotic events, such as high-risk aPL profiles
  • Treatment involving steps similar to those taken in regular cardiovascular disease prevention
  • Advising patients prescribed vitamin K antagonists on the importance of adhering to treatment guidelines, including potential interactions with food and other drugs

The full 12 recommendations can be read here. Generally, though, they address possible primary and secondary means of treatment.

Primary Thromboprophylaxis

For asymptomatic carriers, or individuals with high-risk aPL profiles, a daily low-dose (75-100mg) aspirin may be recommended. In individuals with low-risk profiles or obstetric APS only, low-dose aspirin may not even be recommended.

Secondary Thromboprophylaxis

The secondary prophylactic measures outlined by the EULAR are much more varied, but may involve the administration of vitamin K antagonists with confirmed cases of APS. If further countermeasures are found to be necessary, a low-dose aspirin or heparin (a common anticoagulant) injection may be additionally administered.

For obstetric APS, the EULAR recommends preventative low-dose aspirin in women with high-risk aPL profiles. Women with a history of premature birth may be recommended a combination therapy of low-dose aspirin and heparin.

“Catastrophic” APS patients are recommended therapy involving the administration of glucocorticoids (steroids) and heparin, as well as regular plasma exchange or immunoglobulin supplementation.

Further Study Might Be Necessary

Many of the studies the EULA based their recommendations on provided “low certainty” of evidence. Many failed to distinguish between patients displaying a number of clinical features and often did not differentiate between arterial and venous cases.

“This resulted in only indirect evidence for many of the treatment decisions that were examined,” the group wrote. Nonetheless, the EULA’s outline provide a solid foundation for treatment, and will likely act as a springboard into more research and better understanding of antiphospholipid syndrome.

Decisions about treatment are informed by the scientific understanding of a condition. Why is it important for studies to be as specific as possible in terms of who it recruits, and in what cohorts? How does data collection influence real health outcomes? Share your thoughts with Patient Worthy!

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