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How we treat” clinical dilemmas in antiphospholipid syndrome: A case-based approach

  • Author Footnotes
    1 These authors contributed equally to this work.
    Irene Cecchi
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK- net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley (North-West Italy), San Giovanni Bosco Hub Hospital and University of Turin, Turin, Italy

    School of Specialization of Clinical Pathology, Department of Clinical and Biological Sciences, University of Turin, Italy
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  • Author Footnotes
    1 These authors contributed equally to this work.
    Massimo Radin
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK- net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley (North-West Italy), San Giovanni Bosco Hub Hospital and University of Turin, Turin, Italy

    School of Specialization of Clinical Pathology, Department of Clinical and Biological Sciences, University of Turin, Italy
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  • Silvia Grazietta Foddai
    Affiliations
    University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK- net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley (North-West Italy), San Giovanni Bosco Hub Hospital and University of Turin, Turin, Italy
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  • Marta Arbrile
    Affiliations
    University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK- net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley (North-West Italy), San Giovanni Bosco Hub Hospital and University of Turin, Turin, Italy

    School of Specialization of Clinical Pathology, Department of Clinical and Biological Sciences, University of Turin, Italy
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  • Alice Barinotti
    Affiliations
    University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK- net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley (North-West Italy), San Giovanni Bosco Hub Hospital and University of Turin, Turin, Italy
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  • Elena Rubini
    Affiliations
    University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK- net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley (North-West Italy), San Giovanni Bosco Hub Hospital and University of Turin, Turin, Italy
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  • Alessandro Morotti
    Affiliations
    Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
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  • Vittorio Pengo
    Affiliations
    Thrombosis Research Laboratory, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy

    Arianna Foundation on Anticoagulation, Bologna, Italy
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  • Dario Roccatello
    Affiliations
    University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK- net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley (North-West Italy), San Giovanni Bosco Hub Hospital and University of Turin, Turin, Italy

    School of Specialization of Clinical Pathology, Department of Clinical and Biological Sciences, University of Turin, Italy
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  • Savino Sciascia
    Correspondence
    Corresponding author at: Center of Research of Immunopathology and Rare Diseases- Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, and SCDU Nephrology and Dialysis, Department of Clinical and Biological Sciences, S. Giovanni Bosco Hospital, University of Turin, Piazza del Donatore di Sangue 3, Turin 10154, Italy.
    Affiliations
    University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK- net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley (North-West Italy), San Giovanni Bosco Hub Hospital and University of Turin, Turin, Italy

    School of Specialization of Clinical Pathology, Department of Clinical and Biological Sciences, University of Turin, Italy
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this work.
Published:October 19, 2022DOI:https://doi.org/10.1016/j.ejim.2022.10.010

      Highlights

      • VKA cease might be considered in specific cases after a careful risk assessment.
      • CV risk factors control is mandatory in APS patients after ischemic stroke.
      • Additional tests in single LA positive patients are warranted to avoid overtreatment.
      • ENA profiling and “extra-criteria aPL” testing are keys for preconception counseling.

      Abstract

      Antiphospholipid syndrome (APS) is an autoimmune condition characterized by thrombosis (arterial, venous, and microvascular) and/or pregnancy morbidity occurring in subjects persistently positive for antiphospholipid antibodies (aPL). While the APS classification criteria are being currently updated to improve homogeneity in clinical research, patients who seek medical treatment often have a variety of laboratory and clinical characteristics that may not completely fulfill the classification criteria for overt APS. Those cases might represent a challenge in terms of treatment and overall management.
      We aim to present a collection of challenging scenarios of patients who tested positive for aPL and to discuss available literature to guide the therapeutic strategies.

      Keywords

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