Therapeutische Aspekte beim Antiphospholipidsyndrom

Zusammenfassung

Das Antiphospholipidsyndrom (APS) wird klinisch durch venöse oder arterielle Thrombosen sowie Schwangerschaftskomplikationen gekennzeichnet und serologisch durch den Nachweis von Antiphospholipidantikörpern (aPL) bzw. eines Lupusantikoagulans (LA). In den letzten Jahren wurde evident, dass insbesondere bei Vorliegen aller drei serologischen Kriterien, Antikörper gegen Cardiolipin (aCL), gegen ß2-Glykoprotein-1 (aß2-GP1) und ein positives Lupusantikoagulans, die sog. Triple-Positivität, das Risiko für (weitere) thromboembolische und geburtshilfliche Komplikationen deutlich erhöht ist. Therapeutisch werden Thrombozytenaggregationshemmer (ASS), Heparin und Vitamin K Antagonisten eingesetzt. Von der Verwendung direkter oraler Antikoagulantien beim APS wird abgeraten. Eine Immunsuppression ist für die Vermeidung weiterer thromboembolischer Komplikationen eines APS nicht wirksam.

Abstract

The antiphospholipid syndrome (APS) is characterised clinically by venous or arterial thrombosis and pregnancy complications and serologically by the detection of antiphospholipid antibodies (aPL) or a lupus anticoagulant (LA). In recent years, it has become evident that the risk of (further) thromboembolic and obstetric complications is significantly increased if all three serological criteria are present: antibodies against cardiolipin (aCL), antibodies against ß2-glycoprotein-1 (aß2-GP1), and a positive lupus anticoagulant – a constellation called triple positivity. Low-dose aspirin (LDA), heparin and vitamin K antagonists are the mainstays of treatment. The use of direct oral anticoagulants in APS is not recommended. Immunosuppression is not effective in preventing further thromboembolic manifestations of APS.

Schlüsselwörter

Antiphospholipidsyndrom - Anticardiolipinantikörper - Lupusantikoagulans - Antikoagulation - Lupus erythematodes

Key words

antiphospholipid syndrome - anticardiolipin antibodies - anticoagulation - lupus erythematosus - lupus anticoagulant

Publikationsverlauf

Artikel online veröffentlicht:
03. November 2022

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