Actualización y estrategias terapéuticas en el síndrome antifosfolípido

Abstract

Background: antiphospholipid syndrome is a thrombogenic (autoimmune) condition in which the fundamental strategy is immunosuppression and thromboprophylaxis. Data comparing direct oral anticoagulants (DOAC) with vitamin K antagonists (VKA) remain controversial. Objective: to describe the use of anticoagulants in antiphospholipid syndrome. Methodology: a literature review was conducted by combining eight studies with a range of interquartile points from I to IV according to Scimago Journal & Country Rank. Each study had a level of evidence between I and III. Result: HIV infection increases the levels of anticardiolipin antibodies (aCL) (RR 10.5), HCV (RR 6.3), HBV (RR 4.2), EBV (RR 10.9), and increased anti-b2-GPI antibodies by HCV (RR 4.8). In addition, human leukocyte antigen (HLA) class II genes are associated with the disease. In patients with PFS who used DOACS, the risk of thromboembolic events increased (RR 1.69), in patients with arterial type (RR 2.61 to 5.43), especially stroke, and the combination of arterial thrombotic events or VTE (OR: 4.46). As for rivaroxaban (the most representative drug of the DOACs), the thromboembolic risk was even higher compared to the other DOACs studied (RR 2.63 to 3.36). Conclusions: according to the literature, there is a risk of developing aCL and b2-GPI antibodies in several viral infections. The use of DOACs (rivaroxaban) seems less effective than VKAs in thromboprophylaxis, with a higher risk of thromboembolic events.