Management of Cardiovascular Complications in Antiphospholipid Syndrome: A Narrative Review with a Focus on Older Adults.
| Title: | Management of Cardiovascular Complications in Antiphospholipid Syndrome: A Narrative Review with a Focus on Older Adults. |
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| Authors: | Bernardi M; Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Piazzale A. Moro 5, 00185 Rome, Italy.; Spadafora L; Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Piazzale A. Moro 5, 00185 Rome, Italy.; Andaloro S; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy.; Piscitelli A; Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy.; Fornaci G; Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Piazzale A. Moro 5, 00185 Rome, Italy.; Intonti C; Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Piazzale A. Moro 5, 00185 Rome, Italy.; Fratta AE; Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy.; Hsu CE; Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy.; Kaziròd-Wolski K; Institute of Medical Sciences, Collegium Medicum, Jan Kochanowski University, Al. IX Wieków Kielc 19A, 25-317 Kielce, Poland.; Metsovitis T; Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy.; Biondi-Zoccai G; Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Via XXIV Maggio 7, 04100 Latina, Italy.; Cardiology Unit, Santa Maria Goretti Hospital, Via L. Scaravelli, 04100 Latina, Italy.; Sabouret P; Heart Institute, Pitié-Salpétrière Hospital, Sorbonne University, 47-83 Bd. de l'Hôpital, 75013 Paris, France.; National College of French Cardiologists, 13 Niepce, 75014 Paris, France.; Marzetti E; Department of Geriatrics, Orthopedics, and Rheumatology, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy.; Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy.; Cacciatore S; Department of Geriatrics, Orthopedics, and Rheumatology, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy. |
| Source: | Journal of clinical medicine [J Clin Med] 2024 May 23; Vol. 13 (11). Date of Electronic Publication: 2024 May 23. |
| Publication Type: | Journal Article; Review |
| Language: | English |
| Journal Info: | Publisher: MDPI AG Country of Publication: Switzerland NLM ID: 101606588 Publication Model: Electronic Cited Medium: Print ISSN: 2077-0383 (Print) Linking ISSN: 20770383 NLM ISO Abbreviation: J Clin Med Subsets: PubMed not MEDLINE |
| Imprint Name(s): | Original Publication: Basel, Switzerland : MDPI AG, [2012]- |
| Abstract: | Antiphospholipid syndrome (APS), also known as Hughes syndrome, is an acquired autoimmune and procoagulant condition that predisposes individuals to recurrent thrombotic events and obstetric complications. Central is the role of three types of antiphospholipid antibodies that target phospholipid-binding proteins: lupus anticoagulant (LAC), anti-β2-glycoprotein I (β2-GPI-Ab), and anti-cardiolipin (aCL). Together with clinical data, these antibodies are the diagnostic standard. However, the diagnosis of APS in older adults may be challenging and, in the diagnostic workup of thromboembolic complications, it is an underestimated etiology. The therapeutic management of APS requires distinguishing two groups with differential risks of thromboembolic complications. The standard therapy is based on low-dose aspirin in the low-risk group and vitamin K antagonists in the high-risk group. The value of direct oral anticoagulants is currently controversial. The potential role of monoclonal antibodies is investigated. For example, rituximab is currently recommended in catastrophic antiphospholipid antibody syndrome. Research is ongoing on other monoclonal antibodies, such as daratumumab and obinutuzumab. This narrative review illustrates the pathophysiological mechanisms of APS, with a particular emphasis on cardiovascular complications and their impact in older adults. This article also highlights advancements in the diagnosis, risk stratification, and management of APS. |
| References: | Cureus. 2021 Aug 8;13(8):e17002. (PMID: 34540404); J Rheumatol. 2002 Dec;29(12):2531-6. (PMID: 12465147); Mol Hum Reprod. 2016 Jul;22(7):465-74. (PMID: 27029214); J Thromb Haemost. 2022 Sep;20(9):2136-2150. (PMID: 35713971); Ann Rheum Dis. 2015 Jun;74(6):1011-8. (PMID: 24464962); Am J Med. 1995 May;98(5):511-3. (PMID: 7733133); Best Pract Res Clin Rheumatol. 2008 Oct;22(5):847-61. (PMID: 19028367); N Engl J Med. 2018 Oct 18;379(16):1509-1518. (PMID: 30221597); Ann Rheum Dis. 2009 Sep;68(9):1428-32. (PMID: 18801761); Arthritis Rheumatol. 2021 Oct;73(10):1780-1790. (PMID: 34114366); Semin Arthritis Rheum. 1994 Jun;23(6):357-66. (PMID: 7939722); Science. 2021 Mar 12;371(6534):. (PMID: 33707237); Thromb Res. 2021 Feb;198:213-221. (PMID: 33485122); J Reprod Immunol. 2008 Jan;77(1):51-6. (PMID: 17418423); J Rheumatol. 2004 Dec;31(12):2402-7. (PMID: 15570641); Curr Probl Cardiol. 2023 Mar;48(3):101503. (PMID: 36402221); Lupus. 1996 Oct;5(5):354-63. (PMID: 8902760); Rheumatology (Oxford). 2022 Jul 6;61(7):2894-2904. (PMID: 34788412); Curr Rheumatol Rep. 2022 Jan 5;23(12):85. (PMID: 34985614); Med Sci Monit. 2005 Sep;11(9):CR430-3. (PMID: 16127362); Eur J Cardiothorac Surg. 2010 Jan;37(1):154-8. (PMID: 19699100); Int J Mol Sci. 2024 Jan 04;25(1):. (PMID: 38203837); Clin Exp Rheumatol. 1992 Sep-Oct;10(5):455-60. (PMID: 1458697); Curr Rheumatol Rep. 2013 Apr;15(4):320. (PMID: 23456852); Am J Transplant. 2013 Aug;13(8):2179-85. (PMID: 23763583); J Control Release. 2022 Oct;350:584-599. (PMID: 36037975); Lupus. 2005;14(9):736-41. (PMID: 16218478); Clin Exp Immunol. 1987 Sep;69(3):557-65. (PMID: 3499270); J Thromb Haemost. 2006 Feb;4(2):295-306. (PMID: 16420554); Blood. 2003 Mar 1;101(5):1827-32. (PMID: 12393574); Lancet. 1996 Aug 17;348(9025):423-8. (PMID: 8709780); Proc Natl Acad Sci U S A. 1991 Apr 15;88(8):3069-73. (PMID: 2014226); Isr Med Assoc J. 2014 Mar;16(3):162-7. (PMID: 24761704); Arthritis Rheum. 2006 Dec;54(12):3918-25. (PMID: 17133599); Curr Opin Rheumatol. 2014 May;26(3):269-75. (PMID: 24646948); Chin Med J (Engl). 2020 Apr 20;133(8):929-940. (PMID: 32265421); Haemostasis. 1994 May-Jun;24(3):175-82. (PMID: 7988947); J Thorac Cardiovasc Surg. 2004 Feb;127(2):414-20. (PMID: 14762349); N Engl J Med. 2018 May 24;378(21):2010-2021. (PMID: 29791828); Lupus. 2022 Apr;31(5):624-627. (PMID: 35382632); Circulation. 1996 Apr 15;93(8):1579-87. (PMID: 8608627); Arthritis Rheum. 2002 Apr;46(4):1019-27. (PMID: 11953980); Arthritis Rheumatol. 2020 Dec;72(12):2130-2135. (PMID: 32729667); Blood Coagul Fibrinolysis. 2022 Oct 1;33(7):389-401. (PMID: 35867933); Ann Intern Med. 1992 Aug 15;117(4):303-8. (PMID: 1637025); J Intern Med. 2022 Mar;291(3):327-337. (PMID: 34820922); Blood. 2015 Apr 30;125(18):2835-44. (PMID: 25733579); Circulation. 2011 Jul 12;124(2):215-24. (PMID: 21690492); Am J Med Sci. 2014 Jul;348(1):65-70. (PMID: 24805784); J Thromb Haemost. 2011 Oct;9(10):1985-92. (PMID: 21794077); J Thromb Haemost. 2018 Aug;16(8):1656-1664. (PMID: 29978552); Clin Exp Immunol. 1997 Aug;109(2):304-9. (PMID: 9276526); Semin Thromb Hemost. 2008 Apr;34(3):290-4. (PMID: 18720310); Arthritis Rheumatol. 2023 Oct;75(10):1687-1702. (PMID: 37635643); Blood Coagul Fibrinolysis. 2018 Jul;29(5):472-475. (PMID: 29939846); Rheumatology (Oxford). 2017 Jul 1;56(7):1227-1237. (PMID: 28407142); BMJ Case Rep. 2020 Feb 9;13(2):. (PMID: 32041760); J Rheumatol. 1995 Sep;22(9):1694-7. (PMID: 8523347); Autoimmun Rev. 2010 Feb;9(4):200-2. (PMID: 19386286); Thromb Haemost. 1994 May;71(5):670-4. (PMID: 8091396); J Clin Med. 2022 Jan 29;11(3):. (PMID: 35160188); Front Cardiovasc Med. 2021 Aug 03;8:715878. (PMID: 34414220); Rheumatology (Oxford). 2019 Jun 1;58(6):1006-1010. (PMID: 30608611); Int J Cardiol Heart Vasc. 2019 Feb 01;22:148-149. (PMID: 30766913); Lupus. 2012 Dec;21(14):1497-505. (PMID: 22933620); Arthritis Rheumatol. 2019 Sep;71(9):1545-1552. (PMID: 30957430); J Autoimmun. 2017 Jan;76:10-20. (PMID: 27776934); Blood. 2011 Oct 27;118(17):4714-8. (PMID: 21765019); Clin Hypertens. 2022 Apr 1;28(1):10. (PMID: 35361265); Lupus. 1996 Jun;5(3):206-11. (PMID: 8803891); Autoimmun Rev. 2006 Mar;5(3):195-201. (PMID: 16483919); G Ital Cardiol (Rome). 2024 Apr;25(4):229-238. (PMID: 38526359); Lupus. 2015 Aug;24(9):980-4. (PMID: 25697769); Arch Intern Med. 2005 Jul 11;165(13):1527-32. (PMID: 16009869); J Thromb Haemost. 2008 Aug;6(8):1405-12. (PMID: 18485085); Circulation. 2003 Jun 17;107(23 Suppl 1):I9-16. (PMID: 12814980); Semin Immunopathol. 2022 May;44(3):347-362. (PMID: 35122116); J Rheumatol. 1998 Jul;25(7):1313-9. (PMID: 9676762); Autoimmun Rev. 2022 Mar;21(3):102990. (PMID: 34740852); Arthritis Rheum. 2012 Aug;64(8):2719-23. (PMID: 22354668); Thromb Res. 2024 May;237:88-93. (PMID: 38569453); Arthritis Rheum. 2007 Dec 15;57(8):1487-95. (PMID: 18050167); Arthritis Rheum. 2005 May;52(5):1545-54. (PMID: 15880836); Blood Adv. 2022 Feb 22;6(4):1271-1277. (PMID: 35051999); J Thromb Haemost. 2019 Jul;17(7):1134-1143. (PMID: 30864219); Front Immunol. 2019 Mar 05;10:376. (PMID: 30891041); Int J Cardiol. 2019 Sep 1;290:1-6. (PMID: 31133433); Lupus. 1992 Feb;1(2):91-6. (PMID: 1301969); Ann Rheum Dis. 2019 Feb;78(2):155-161. (PMID: 30282668); Blood. 2011 Jan 27;117(4):1408-14. (PMID: 21119114); J Autoimmun. 2009 May-Jun;32(3-4):240-5. (PMID: 19324520); J Clin Med. 2023 Apr 20;12(8):. (PMID: 37109332); Arthritis Rheumatol. 2016 Mar;68(3):730-739. (PMID: 26474194); J Hepatol. 1994 Dec;21(6):1086-91. (PMID: 7699232); Lupus. 2014 Dec;23(14):1468-76. (PMID: 25164304); Autoimmun Rev. 2015 Mar;14(3):192-200. (PMID: 25461472); Lancet Haematol. 2016 Sep;3(9):e426-36. (PMID: 27570089); Eur Heart J. 2022 Feb 12;43(7):561-632. (PMID: 34453165); Eur J Cardiothorac Surg. 2008 Feb;33(2):168-81. (PMID: 18082413); Thromb Res. 2014 Feb;133(2):173-6. (PMID: 24321419); Curr Rheumatol Rep. 2016 Dec;18(12):74. (PMID: 27812956); Am J Med. 1996 May;100(5):530-6. (PMID: 8644765); Arthritis Rheum. 2009 Jan 15;61(1):29-36. (PMID: 19116963); Thromb Res. 2000 Jul 15;99(2):129-33. (PMID: 10946086); Lupus. 2003;12(5):341-55. (PMID: 12765297); Arthritis Res Ther. 2018 May 2;20(1):85. (PMID: 29720240); J Rheumatol. 2006 Aug;33(8):1559-62. (PMID: 16832847); Autoimmun Rev. 2015 Mar;14(3):214-22. (PMID: 25461836); Int J Stroke. 2023 Apr;18(4):383-391. (PMID: 36571450); Front Immunol. 2019 May 10;10:941. (PMID: 31134062); Blood. 2004 Mar 15;103(6):2121-6. (PMID: 14630788); Thromb Res. 2015 Jan;135(1):46-9. (PMID: 25456002); J Thromb Haemost. 2009 Nov;7(11):1767-73. (PMID: 19694946); Circulation. 1998 Jun 9;97(22):2195-6. (PMID: 9631867); J Korean Med Sci. 2020 Feb 10;35(5):e35. (PMID: 32030922); Lupus. 2013 Jul;22(8):865-7. (PMID: 23740031); Neuroepidemiology. 2002 Mar-Apr;21(2):93-9. (PMID: 11901279); J Thromb Haemost. 2015 Oct;13(10):1928-40. (PMID: 26264622); J Cardiothorac Surg. 2020 Sep 29;15(1):275. (PMID: 32993710); Lupus. 2022 Dec;31(14):1816-1823. (PMID: 36177950); Ann Intern Med. 2019 Nov 19;171(10):685-694. (PMID: 31610549) |
| Grant Information: | D1.2020 Università Cattolica del Sacro Cuore; D1.2022 Università Cattolica del Sacro Cuore; D1.2023 Università Cattolica del Sacro Cuore; N/A Centro Studi Achille e Linda Lorenzon; DM 1557 11.10.2022 European Commission |
| Contributed Indexing: | Keywords: anti-cardiolipin antibodies; anti-β2-glycoprotein I antibodies; lupus anticoagulant; miRNA; monoclonal antibodies; stroke; thrombosis |
| Entry Date(s): | Date Created: 20240619 Latest Revision: 20240620 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC11173304 |
| DOI: | 10.3390/jcm13113064 |
| PMID: | 38892776 |
| Database: | MEDLINE |
Journal Article; Review