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  • Editorial: Outcomes of Revascularization in Anti-Phospholipid Syndrome (APS): Challenges and Quests

    Patients with anti-phospholipid syndrome (APS) are at increased risk for recurrent arterial thrombotic events, at least in part mediated by the autoantibodies in interaction with environmental factors. The diagnostic criteria of APS require one clinical event (i.e., thrombosis or pregnancy complication) and two independent antibody blood tests, taken three months apart, that confirm the presence of lupus anticoagulant or antiphospholipid antibodies. Lupus anticoagulants (LA) are a heterogeneous group of autoantibodies that are detected by abnormalities in coagulation and prolongation of clotting and thrombin time, measured by LA assay. In contrast, enzyme-linked immunosorbent assays (ELISA) are used for detection of specific antiphospholipid antibodies, immunoglobulins G [IgG] or M [IgM], against cardiolipin (aCL) and β2-glycoprotein-I. Previous reports have found an association between presence of aCL antibodies and recurrent cardiac events in patients with acute coronary syndrome, suggesting that these patients may be at higher risk for complications of revascularization procedures. Similarly, Gürlek A et al. reported an association between aCL antibodies and recurrent cardiac events in patients with acute coronary syndrome with restenosis, which was observed in 40% of patients with positive aCL antibody versus 14% in patients without aCL. There is a paucity of data on the treatment of arterial thrombosis in patients with APS, and limited evidence exists to guide the use of combination of antiplatelet and anticoagulant therapy in the setting of initial and recurring events.

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