Cardiac disease in the antiphospholipid syndrome: recommendations for treatment. Committee consensus report
Identifieur interne : 002125 ( Main/Exploration ); précédent : 002124; suivant : 002126Cardiac disease in the antiphospholipid syndrome: recommendations for treatment. Committee consensus report
Auteurs : M. Lockshin [États-Unis] ; F. Tenedios [États-Unis] ; M. Petri [États-Unis] ; G. Mccarty [États-Unis] ; R. Forastiero [Argentine] ; S. Krilis [Australie] ; A. Tincani [Italie] ; D. Erkan [États-Unis] ; M A Khamashta [Royaume-Uni] ; Y. Shoenfeld [Israël]Source :
- Lupus [ 0961-2033 ] ; 2003-07.
English descriptors
- Teeft :
- Abnormality, Anticoagulation, Antiphospholipid, Antiphospholipid antibody, Antiphospholipid antibody syndrome, Antiphospholipid syndrome, Arthritis rheum, Asymptomatic patients, Atherosclerosis, Cardiac, Cardiac disease, Carotid, Chronic thromboembolic, Clinical trials, Cohort, Corticosteroid therapy, Diastolic, Diastolic dysfunction, Dysfunction, Erythematosus, Hopkins lupus cohort, Hypertension, Intracardiac thrombi, Lockshin, Lupus, Lupus anticoagulant, Myocardial infarction, Pap, Paps patients, Petri, Population studies, Primary antiphospholipid syndrome, Pulmonary hypertension, Reliable gures, Rheum, Risk factors, Sapporo criteria, Statin, Syndrome, Systemic lupus erythematosus, Thrombosis, Treatment implications, Unpublished data, Valve, Valve abnormalities, Valve disease, Valve lesions, Valvular heart disease, Ventricular, Ventricular diastolic function, Ventricular hypertrophy, Warfarin.
Abstract
The Committee reviewed cardiac involvement in the antiphospholipid antibody syndrome. The Committee’s recommendations are: Valve abnormalities: anticoagulation is recommended for symptomatic patients with valvulopathy. Prophylactic antiplatelet therapy may be appropriate for asymptomatic patients (recommended by 13/17 experts in an independent review). Committee members disagreed whether corticosteroid therapy is helpful, but agree that distinguishing among presumptive valvulitis (valve thickening on echocardiogram), valve deformity and vegetations is important, as treatment implications may differ. Occlusive arterial disease (angina, myocardial infarction): the Committee recommends aggressive treatment of all risk factors for atherosclerosis (hypertension, hypercholesterolaemia, smoking) and liberal use of folic acid, B vitamins and cholesterol-lowering drugs (preferably statins). Hydroxychloroquine for cardiac protection in APS patients may be considered. The Committee also recommends warfarin anticoagulationfor those who have suffered thrombosis in the absence of atherosclerosis, but recognizesthat developingdata may support the use of antiplateletagents instead. Intracardiac thrombi: the Committee recommends intensive warfarin anticoagulation, and consultation with cardiac surgeons when appropriate. Ventricular dysfunction: the Committee has no recommendations on this aspect of cardiac disease. Pulmonary hypertension: the Committee recommends intensive anticoagulationwith warfarin and clinical trials of bosentan, epoprostenol and other new agents.
Url:
DOI: 10.1191/0961203303lu391oa
Affiliations:
- Argentine, Australie, Israël, Italie, Royaume-Uni, États-Unis
- Angleterre, Grand Londres, Maryland, Virginie, État de New York
- Londres
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Shoenfeld</name><affiliation wicri:level="1"><country xml:lang="fr">Israël</country><wicri:regionArea>Chaim Sheba Medical Center, Tel-Hashomer</wicri:regionArea><wicri:noRegion>Tel-Hashomer</wicri:noRegion></affiliation></author></analytic><monogr></monogr><series><title level="j">Lupus</title><idno type="ISSN">0961-2033</idno><idno type="eISSN">1477-0962</idno><imprint><publisher>Sage Publications</publisher><pubPlace>Sage CA: Thousand Oaks, CA</pubPlace><date type="published" when="2003-07">2003-07</date><biblScope unit="volume">12</biblScope><biblScope unit="issue">7</biblScope><biblScope unit="page" from="518">518</biblScope><biblScope unit="page" to="523">523</biblScope></imprint><idno type="ISSN">0961-2033</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0961-2033</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="Teeft" xml:lang="en"><term>Abnormality</term><term>Anticoagulation</term><term>Antiphospholipid</term><term>Antiphospholipid antibody</term><term>Antiphospholipid antibody syndrome</term><term>Antiphospholipid syndrome</term><term>Arthritis rheum</term><term>Asymptomatic patients</term><term>Atherosclerosis</term><term>Cardiac</term><term>Cardiac disease</term><term>Carotid</term><term>Chronic thromboembolic</term><term>Clinical trials</term><term>Cohort</term><term>Corticosteroid therapy</term><term>Diastolic</term><term>Diastolic dysfunction</term><term>Dysfunction</term><term>Erythematosus</term><term>Hopkins lupus cohort</term><term>Hypertension</term><term>Intracardiac thrombi</term><term>Lockshin</term><term>Lupus</term><term>Lupus anticoagulant</term><term>Myocardial infarction</term><term>Pap</term><term>Paps patients</term><term>Petri</term><term>Population studies</term><term>Primary antiphospholipid syndrome</term><term>Pulmonary hypertension</term><term>Reliable gures</term><term>Rheum</term><term>Risk factors</term><term>Sapporo criteria</term><term>Statin</term><term>Syndrome</term><term>Systemic lupus erythematosus</term><term>Thrombosis</term><term>Treatment implications</term><term>Unpublished data</term><term>Valve</term><term>Valve abnormalities</term><term>Valve disease</term><term>Valve lesions</term><term>Valvular heart disease</term><term>Ventricular</term><term>Ventricular diastolic function</term><term>Ventricular hypertrophy</term><term>Warfarin</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">The Committee reviewed cardiac involvement in the antiphospholipid antibody syndrome. The Committee’s recommendations are: Valve abnormalities: anticoagulation is recommended for symptomatic patients with valvulopathy. Prophylactic antiplatelet therapy may be appropriate for asymptomatic patients (recommended by 13/17 experts in an independent review). Committee members disagreed whether corticosteroid therapy is helpful, but agree that distinguishing among presumptive valvulitis (valve thickening on echocardiogram), valve deformity and vegetations is important, as treatment implications may differ. Occlusive arterial disease (angina, myocardial infarction): the Committee recommends aggressive treatment of all risk factors for atherosclerosis (hypertension, hypercholesterolaemia, smoking) and liberal use of folic acid, B vitamins and cholesterol-lowering drugs (preferably statins). Hydroxychloroquine for cardiac protection in APS patients may be considered. The Committee also recommends warfarin anticoagulationfor those who have suffered thrombosis in the absence of atherosclerosis, but recognizesthat developingdata may support the use of antiplateletagents instead. Intracardiac thrombi: the Committee recommends intensive warfarin anticoagulation, and consultation with cardiac surgeons when appropriate. Ventricular dysfunction: the Committee has no recommendations on this aspect of cardiac disease. Pulmonary hypertension: the Committee recommends intensive anticoagulationwith warfarin and clinical trials of bosentan, epoprostenol and other new agents.</div></front></TEI><affiliations><list><country><li>Argentine</li><li>Australie</li><li>Israël</li><li>Italie</li><li>Royaume-Uni</li><li>États-Unis</li></country><region><li>Angleterre</li><li>Grand Londres</li><li>Maryland</li><li>Virginie</li><li>État de New York</li></region><settlement><li>Londres</li></settlement></list><tree><country name="États-Unis"><noRegion><name sortKey="Lockshin, M" sort="Lockshin, M" uniqKey="Lockshin M" first="M" last="Lockshin">M. Lockshin</name></noRegion><name sortKey="Erkan, D" sort="Erkan, D" uniqKey="Erkan D" first="D" last="Erkan">D. Erkan</name><name sortKey="Mccarty, G" sort="Mccarty, G" uniqKey="Mccarty G" first="G" last="Mccarty">G. Mccarty</name><name sortKey="Petri, M" sort="Petri, M" uniqKey="Petri M" first="M" last="Petri">M. Petri</name><name sortKey="Tenedios, F" sort="Tenedios, F" uniqKey="Tenedios F" first="F" last="Tenedios">F. Tenedios</name></country><country name="Argentine"><noRegion><name sortKey="Forastiero, R" sort="Forastiero, R" uniqKey="Forastiero R" first="R" last="Forastiero">R. Forastiero</name></noRegion></country><country name="Australie"><noRegion><name sortKey="Krilis, S" sort="Krilis, S" uniqKey="Krilis S" first="S" last="Krilis">S. Krilis</name></noRegion></country><country name="Italie"><noRegion><name sortKey="Tincani, A" sort="Tincani, A" uniqKey="Tincani A" first="A" last="Tincani">A. Tincani</name></noRegion></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Khamashta, M A" sort="Khamashta, M A" uniqKey="Khamashta M" first="M A" last="Khamashta">M A Khamashta</name></region></country><country name="Israël"><noRegion><name sortKey="Shoenfeld, Y" sort="Shoenfeld, Y" uniqKey="Shoenfeld Y" first="Y" last="Shoenfeld">Y. Shoenfeld</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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