Antiphospholipid syndrome (APS) is an autoimmune prothrombotic disorder mediated by a heterogeneous group of autoantibodies collectively known as antiphospholipid antibodies (aPL). They include lupus anticoagulant (LA), IgG and IgM anticardiolipin antibodies (aCL) and anti-β2-glycoprotein I (anti-β2GPI) antibodies. It has been shown that those patients with all three aPL (triple positive) are at highest risk of both a first thrombotic event and of a recurrence, despite anticoagulation. In response to publication of a meta-analysis and a randomised controlled trial assessing the safety and efficacy of rivaroxaban versus warfarin in triple-positive APS with venous and/or arterial thrombosis, the Medicines and Healthcare Products Regulatory Agency (MHRA) and European Medicines Agency (EMA) issued recommendations that direct-acting oral anticoagulant (DOACs) should not be used for secondary prevention of thrombosis in all APS patients (although they did draw specific attention to the high risk of triple-positive patients). As there is less evidence for patients with single- or dual-positive patients with APS, this may be an over-interpretation of the data. In this review, we explore the available evidence on safety and efficacy of DOACs in thrombotic APS, the problem of detecting LA while on DOAC, and provide some practical guidance for managing this problem.

中文翻译：

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血栓性抗磷脂综合征的适当抗凝策略是什么？

抗磷脂综合征（APS）是由异种自身抗体介导的自身免疫性血栓形成疾病，统称为抗磷脂抗体（aPL）。它们包括狼疮抗凝剂（LA），IgG和IgM抗心磷脂抗体（aCL）和抗β2-糖蛋白I（抗β2GPI）抗体。研究表明，尽管抗凝治疗，所有三个aPL（三联阳性）患者的首次血栓事件和复发风险最高。为了回应一项荟萃分析和一项随机对照试验的评估，该试验评估了利伐沙班与华法林在三联阳性APS合并静脉和/或动脉血栓形成中的安全性和有效性，美国药品和保健产品监管局（MHRA）和欧洲药品管理局（EMA）发布了建议，不应将直接作用的口服抗凝剂（DOAC）用于所有APS患者的血栓形成的二级预防（尽管他们确实特别注意了三阳性患者的高风险）。由于对于APS单阳性或双阳性患者的证据较少，这可能是对数据的过度解释。在这篇综述中，我们探索了在血栓性APS中使用DOAC的安全性和有效性的现有证据，在使用DOAC时检测LA的问题，并为管理该问题提供了一些实践指导。由于对于APS单阳性或双阳性患者的证据较少，这可能是对数据的过度解释。在这篇综述中，我们探索了在血栓性APS中DOAC的安全性和有效性的现有证据，在DOAC时检测LA的问题，并为管理该问题提供了一些实践指导。由于对于APS单阳性或双阳性患者的证据较少，这可能是对数据的过度解释。在这篇综述中，我们探索了在血栓性APS中使用DOAC的安全性和有效性的现有证据，在使用DOAC时检测LA的问题，并为管理该问题提供了一些实践指导。