Can anticoagulation be withdrawn in APS patients after aPL negativization?

Autoimmun Rev. 2024 Jan;23(1):103427. doi: 10.1016/j.autrev.2023.103427. Epub 2023 Aug 25.

Abstract

Long-term vitamin K antagonist (VKA) anticoagulation is the cornerstone of the management of subjects with thrombotic antiphospholipid syndrome (APS). Recent investigations have opened up new discussion points regarding the potential for stopping anticoagulant medication in patients with a history of thrombotic APS who no longer have detectable aPL (the so called aPL negativization). Despite the lack of unanimous agreement, some experts agreed on defining aPL negativization as the presence of two negative determinations, 1 year apart. What to do in order to optimize the management of these subjects with thrombotic APS when aPL turn negative is still a matter of debate. In this review, we aim to summarize the main evidence highlighting the magnitude of aPL negativizing among patients with APS and the features to keep in mind when considering (or not) stopping anticoagulation.

Keywords: Anticoagulant withdrawal; Antiphospholipid antibodies negativization; Antiphospholipid syndrome.

Publication types

  • Review

MeSH terms

  • Antibodies, Antiphospholipid / therapeutic use
  • Anticoagulants / adverse effects
  • Antiphospholipid Syndrome* / complications
  • Antiphospholipid Syndrome* / drug therapy
  • Humans
  • Thrombosis* / drug therapy

Substances

  • Antibodies, Antiphospholipid
  • Anticoagulants