The DOI matches its Crossref record; 69 of the 72 references it cites were found in a registry or an index; 27 of the 77 sources its claims cite were checked for support.
EULAR recommendations for the management of antiphospholipid syndrome in adults
Open accessAbstract
The objective was to develop evidence-based recommendations for the management of antiphospholipid syndrome (APS) in adults. Based on evidence from a systematic literature review and expert opinion, overarching principles and recommendations were formulated and voted. High-risk antiphospholipid antibody (aPL) profile is associated with greater risk for thrombotic and obstetric APS. Risk modification includes screening for and management of cardiovascular and venous thrombosis risk factors, patient education about treatment adherence, and lifestyle counselling. Low-dose aspirin (LDA) is recommended for asymptomatic aPL carriers, patients with systemic lupus erythematosus without prior thrombotic or obstetric APS, and non-pregnant women with a history of obstetric APS only, all with high-risk aPL profiles. Patients with APS and first unprovoked venous thrombosis should receive long-term treatment with vitamin K antagonists (VKA) with a target international normalised ratio (INR) of 2–3. In patients with APS with first arterial thrombosis, treatment with VKA with INR 2–3 or INR 3–4 is recommended, considering the individual’s bleeding/thrombosis risk. Rivaroxaban should not be used in patients with APS with triple aPL positivity. For patients with recurrent arterial or venous thrombosis despite adequate treatment, addition of LDA, increase of INR target to 3–4 or switch to low molecular weight heparin may be considered. In women with prior obstetric APS, combination treatment with LDA and prophylactic dosage heparin during pregnancy is recommended. In patients with recurrent pregnancy complications, increase of heparin to therapeutic dose, addition of hydroxychloroquine or addition of low-dose prednisolone in the first trimester may be considered. These recommendations aim to guide treatment in adults with APS. High-quality evidence is limited, indicating a need for more research.
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Written from the paper’s full text.
TL;DR
This paper presents EULAR evidence-based recommendations for managing antiphospholipid syndrome (APS) in adults, covering risk stratification, thromboprophylaxis, obstetric APS, and catastrophic APS. The recommendations are based on a systematic literature review and expert consensus, with limited high-quality evidence.
Key findings
- High-risk antiphospholipid antibody (aPL) profiles—lupus anticoagulant, double/triple aPL positivity, or persistently high titres—are associated with greater thrombotic and obstetric risk. Low-dose aspirin (LDA) 75–100 mg daily is recommended for asymptomatic aPL carriers, patients with SLE without prior thrombotic or obstetric APS, and non-pregnant women with a history of obstetric APS only, all with high-risk aPL profiles. A meta-analysis of seven observational studies of 460 asymptomatic aPL carriers found first thrombosis risk reduced by half with LDA; in women with obstetric APS without SLE, pooled OR for first thrombosis with LDA was 0.25 (95% CI 0.10 to 0.62).
- For definite APS and first unprovoked venous thrombosis, long-term vitamin K antagonists (VKA) with target INR 2–3 are recommended. For first arterial thrombosis, VKA with INR 2–3 or INR 3–4 is recommended, considering individual bleeding/thrombosis risk. Rivaroxaban should not be used in patients with triple aPL positivity due to excess thromboembolic events in the TRAPS trial. For recurrent arterial or venous thrombosis despite adequate treatment, addition of LDA, increase of INR target to 3–4, or switch to low molecular weight heparin may be considered.
- In obstetric APS, women with prior obstetric APS should receive combination LDA and prophylactic-dose heparin during pregnancy. In recurrent pregnancy complications despite LDA and prophylactic heparin, increasing heparin to therapeutic dose, adding hydroxychloroquine, or adding low-dose prednisolone in the first trimester may be considered. In women with thrombotic APS, LDA plus therapeutic-dose heparin is recommended; observational studies reported live births in 79% of pregnancies on average. For catastrophic APS, combination glucocorticoids, heparin, and plasma exchange or IVIG is recommended first-line; rituximab or eculizumab may be considered for refractory cases.
- The task force developed 3 overarching principles and 12 recommendations. The systematic literature review yielded 7534 articles plus 15 hand-searched articles; after title/abstract review, 670 articles underwent full-text review, 249 underwent data abstraction, 61 were excluded, and 188 were finally considered relevant.
Methods
- The project followed the updated EULAR standardised operating procedure and used the AGREE II tool. The task force included members from 11 European countries: 12 specialists in rheumatology or internal medicine, 2 obstetricians, 2 physicians from vascular medicine/thrombosis centres, 1 healthcare professional, and 2 patient representatives. Thirty-one research questions were formulated using PICO and voted by Delphi method.
- Data sources were PubMed, Embase, and the Cochrane Library, searched for English-language articles from inception through 31 January 2018; one RCT published after this date (TRAPS) was included for safety results. Titles/abstracts were reviewed independently by two literature reviewers; full texts were reviewed independently by three persons. Data abstraction was performed by two reviewers and independently double-checked by the convenor and methodologist.
- Evidence was tabulated with summary of findings tables and pooled estimates where applicable. Draft recommendations were prepared, reviewed, discussed in working groups, and voted at a second task force meeting on 3 September 2018. Levels of evidence and grades of recommendation used Oxford Centre for Evidence-Based Medicine standards; anonymous level of agreement was rated 0–10.
Limitations
- The paper states that the main challenge was low certainty of evidence. Many studies included mixed clinical features and did not provide stratified data for arterial versus venous thrombosis or for different types of obstetric APS, resulting in indirect evidence for many treatment decisions. Meta-analyses also pooled heterogeneous patient groups, and RCTs commonly had high risk of bias and low power due to the rarity of the syndrome.
- The paper states that a significant number of recommendations necessarily relied more, or only, on low-quality evidence or expert opinion. It also notes that cost and availability are not barriers to implementation except for IVIG and plasmapheresis, which were recommended first-line only in catastrophic APS, occurring in less than 1% of patients.
- Evident from the text: several recommendations were based on expert opinion or lacked direct studies, including treatment duration after provoked first venous thrombosis, continuation of prophylactic heparin for 6 weeks postpartum, and management of recurrent pregnancy complications despite LDA and prophylactic heparin. Some supporting evidence came from small observational studies or case series.
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Claims the paper makes
17 Own method · 15 No full text of the sources · 5 Supported · 5 No basis given · 4 Mixed support · 3 Supported so far · 3 Partly supported · 3 Own interpretation · 2 Own result · 1 Not supported · 1 Couldn’t confirm · 1 Sources not found · accuracy not yet measured
At least one cited source doesn’t support this claim or points to a different paper, and none confirmed it — see the verdicts below.
In the paper
“Studies of women with SLE and prior obstetric APS are scarce, but the protective effect of LDA was supported by three retrospective studies that included a minority of patients with SLE.18–20”
§ EULAR recommendations for the management of antiphospholipid syndrome in adults > RECOMMENDATIONS > Primary thromboprophylaxis in aPL-positive subjects
What the sources say
- Not checked — no full text of the sourcecites [18] Erkan, 2001, High thrombosis rate after fetal loss in antiphospholipid syndrome: effective prophylaxis with aspirin, Arthritis Rheum source
- Not checked — no full text of the sourcecites [19] Forastiero, 2005, A prospective study of antibodies to beta2-glycoprotein I and prothrombin, and risk of thrombosis, J Thromb Haemost source
- Disputedcites [20] Ruffatti, 2011, Risk factors for a first thrombotic event in antiphospholipid antibody carriers: a prospective multicentre follow-up study, Ann Rheum Dis sourceExperimental — accuracy not yet measured
Split into 2 atoms — 0 confirmed, 0 partially supported, 2 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Checked by a reasoning model — may be wrong.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Some cited sources support this claim and some don’t — read each source’s verdict below.
In the paper
“Data from an RCT21 reporting exclusively on patients with venous events and pooled data from five studies that included a majority with venous events21–25 showed no additional benefit of a target INR of 3–4 vs INR of 2–3.”
§ EULAR recommendations for the management of antiphospholipid syndrome in adults > RECOMMENDATIONS > Secondary thromboprophylaxis in APS
What the sources say
- Partly supportedcites [21] Crowther, 2003, A comparison of two intensities of warfarin for the prevention of recurrent thrombosis in patients with the antiphospholipid antibody syndrome, N Engl J Med sourceExperimental — accuracy not yet measured
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
- Partly supportedcites [22] Finazzi, 2005, A randomized clinical trial of high-intensity warfarin vs. conventional antithrombotic therapy for the prevention of recurrent thrombosis in patients with the antiphospholipid syndrome (WAPS), J Thromb Haemost sourceExperimental — accuracy not yet measured
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
- Not checked — no full text of the sourcecites [23] Rosove, 1992, Antiphospholipid thrombosis: clinical course after the first thrombotic event in 70 patients, Ann Intern Med source
- Disputedcites [24] Khamashta, 1995, The management of thrombosis in the antiphospholipid-antibody syndrome, N Engl J Med sourceExperimental — accuracy not yet measured
Split into 2 atoms — 0 confirmed, 0 partially supported, 2 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Checked by a reasoning model — may be wrong.
- Not checked — no full text of the sourcecites [25] Ames, 2005, Bleeding and re-thrombosis in primary antiphospholipid syndrome on oral anticoagulation: an 8-year longitudinal comparison with mitral valve replacement and inherited thrombophilia, Thromb Haemost source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
Some cited sources support this claim and some don’t — read each source’s verdict below.
In the paper
“Pooled data from one RCT including only patients with a history of first trimester losses46 and eight supporting observational studies47–54 that did not exclusively study women with early pregnancy losses indicated a higher likelihood of live births with combination treatment with LDA and heparin at prophylactic dosage versus LDA alone.”
§ EULAR recommendations for the management of antiphospholipid syndrome in adults > RECOMMENDATIONS > Obstetric APS
What the sources say
- Not checked — no full text of the sourcecites [46] Rai, 1997, Randomised controlled trial of aspirin and aspirin plus heparin in pregnant women with recurrent miscarriage associated with phospholipid antibodies (or antiphospholipid antibodies), BMJ source
- Not checked — no full text of the sourcecites [47] Lima, 1996, A study of sixty pregnancies in patients with the antiphospholipid syndrome, Clin Exp Rheumatol
- Not checked — no full text of the sourcecites [48] Muñoz-Rodriguez, 1999, Clinical study and follow-up of 100 patients with the antiphospholipid syndrome, Semin Arthritis Rheum source
- Disputedcites [49] Naru, 2010, Pregnancy outcome in women with antiphospholipid syndrome on low-dose aspirin and heparin: a retrospective study, East Mediterr Health J sourceExperimental — accuracy not yet measured
This paper is a retrospective observational study, but its Abstract concludes that aspirin alone and aspirin plus heparin were equally efficacious in women with antiphospholipid syndrome and recurrent miscarriage. Its Introduction reports that other randomized trials favored combination treatment; it does not present its own study as supporting a higher likelihood of live birth with heparin. (LLM, conf=0.84)
Checked by a reasoning model — may be wrong.
- Not checked — no full text of the sourcecites [50] Cohn, 2010, Recurrent miscarriage and antiphospholipid antibodies: prognosis of subsequent pregnancy, J Thromb Haemost source
- Supportedcites [51] Mohamed, 2014, Enoxaparin and aspirin therapy for recurrent pregnancy loss due to anti-phospholipid syndrome (APS), Middle East Fertil Soc J source
The Patients and methods section describes a prospective non-randomized comparison and gives the combination group low-dose aspirin plus enoxaparin 40 mg daily. Its pregnancy-morbidity criteria include losses beyond early pregnancy, and the Results report more live births with combination therapy than with aspirin alone (43/47 versus 15/23). The paper supports its role as one observational study in the cited group; it does not itself pool the studies. (LLM, conf=0.90)
- Not checked — no full text of the sourcecites [52] Ruffatti, 2014, Treatment strategies and pregnancy outcomes in antiphospholipid syndrome patients with thrombosis and triple antiphospholipid positivity. a European multicentre retrospective study, Thromb Haemost source
- Not checked — no full text of the sourcecites [53] Franklin, 2002, Antiphospholipid antibodies (APA) and recurrent pregnancy loss: treating a unique APA positive population, Hum Reprod source
- Disputedcites [54] Laskin, 2009, Low molecular weight heparin and aspirin for recurrent pregnancy loss: results from the randomized, controlled HepASA trial, J Rheumatol sourceExperimental — accuracy not yet measured
The Objectives section says the HepASA trial included women with losses before 32 weeks, and Table 1 (Discussion) records participants with histories of losses after 14 weeks. It was therefore not restricted to first-trimester losses. The Abstract reports no live-birth advantage for heparin plus aspirin over aspirin alone in this trial; the eight observational studies are cited separately in the claiming sentence. (LLM, conf=0.92)
Checked by a reasoning model — may be wrong.
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Some cited sources support this claim and some don’t — read each source’s verdict below.
In the paper
“Pooled data from two retrospective studies and two RCTs21–24 showed that there was no statistically significant difference in thrombosis recurrences between treatment with VKA with a target INR of 3–4 and treatment with INR of 2–3 (relative risk (RR) 0.46 (0.06–3.52)).”
§ EULAR recommendations for the management of antiphospholipid syndrome in adults > RECOMMENDATIONS > Secondary thromboprophylaxis in APS
What the sources say
- Supportedcites [21] Crowther, 2003, A comparison of two intensities of warfarin for the prevention of recurrent thrombosis in patients with the antiphospholipid antibody syndrome, N Engl J Med source
The citation identifies a constituent RCT, not the source of the pooled estimate on its own. The trial description identifies this as a randomized comparison of target INR 3.1–4.0 versus 2.0–3.0, and the Results report no statistically significant difference in recurrent thrombosis (P=0.15). (LLM, conf=0.88)
- Partly supportedcites [22] Finazzi, 2005, A randomized clinical trial of high-intensity warfarin vs. conventional antithrombotic therapy for the prevention of recurrent thrombosis in patients with the antiphospholipid syndrome (WAPS), J Thromb Haemost sourceExperimental — accuracy not yet measured
The Study design and Results sections (page not specified) establish that WAPS is one of the randomized trials comparing high- and conventional-intensity treatment and found no statistically significant difference in recurrent thrombosis. But its pooled analysis includes only WAPS and the Crowther trial; it does not report a pooled analysis of two retrospective studies and two RCTs or the stated RR of 0.46 (0.06–3.52). (LLM, conf=0.86)
- Not checked — no full text of the sourcecites [23] Rosove, 1992, Antiphospholipid thrombosis: clinical course after the first thrombotic event in 70 patients, Ann Intern Med source
- Disputedcites [24] Khamashta, 1995, The management of thrombosis in the antiphospholipid-antibody syndrome, N Engl J Med sourceExperimental — accuracy not yet measured
Table 3 (p. 995) reports fewer recurrent events during warfarin treatment at INR ≥3 than at INR <3: 0.015 versus 0.23 events per patient-year. The Discussion (p. 996) says INR 2–3 did not prevent thrombotic events and recommends maintaining INR above 3, contrary to the claimed finding of no significant difference. This paper does not report the pooled RR of 0.46; its Table 3 relative risks compare each treatment with no treatment, not the two INR targets with each other. (LLM, conf=0.86)
Checked by a reasoning model — may be wrong.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“A recent RCT of rivaroxaban versus warfarin in patients with APS with triple aPL positivity was prematurely terminated due to an excess of thromboembolic events (mostly arterial) in the rivaroxaban arm.7”
§ EULAR recommendations for the management of antiphospholipid syndrome in adults > RECOMMENDATIONS > Secondary thromboprophylaxis in APS
What the sources say
- Supportedcites [7] Pengo, 2018, Rivaroxaban vs warfarin in high-risk patients with antiphospholipid syndrome, Blood source
Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“In a post-hoc analysis of patients with APS included in three RCTs of dabigatran versus warfarin,26 and in one RCT of rivaroxaban versus warfarin in patients with venous thrombotic APS,27 there were no differences in outcomes between treatment with DOACs and VKA for venous thrombosis”
§ EULAR recommendations for the management of antiphospholipid syndrome in adults > RECOMMENDATIONS > Secondary thromboprophylaxis in APS
What the sources say
- Not checked — no full text of the sourcecites [26] Goldhaber, 2016, Efficacy of dabigatran versus warfarin in patients with acute venous thromboembolism in the presence of thrombophilia: findings from RE-COVER®, RE-COVER™ II, and RE-MEDY™, Vasc Med source
- Supportedcites [27] Cohen, 2016, Rivaroxaban versus warfarin to treat patients with thrombotic antiphospholipid syndrome, with or without systemic lupus erythematosus (RAPS): a randomised, controlled, open-label, phase 2/3, non-inferiority trial, Lancet Haematol source
Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Alternatively, treatment with VKA with a target INR of 2–3 plus LDA is used by some experts, supported by limited data from one retrospective cohort study and one small RCT.36 37”
§ EULAR recommendations for the management of antiphospholipid syndrome in adults > RECOMMENDATIONS > Secondary thromboprophylaxis in APS
What the sources say
- Not checked — no full text of the sourcecites [36] Krnic-Barrie, 1997, A retrospective review of 61 patients with antiphospholipid syndrome. Analysis of factors influencing recurrent thrombosis, Arch Intern Med source
- Supportedcites [37] Okuma, 2009, Comparison between single antiplatelet therapy and combination of antiplatelet and anticoagulation therapy for secondary prevention in ischemic stroke patients with antiphospholipid syndrome, Int J Med Sci source
The Materials and Methods section describes a small randomized trial of 20 patients with APS-related ischemic stroke, comparing aspirin alone with aspirin plus anticoagulation targeted to an INR of 2.0–3.0. The Results report fewer recurrent strokes in the combination group, supporting the cited sentence’s description of limited RCT evidence. This paper is not the retrospective cohort study cited alongside it. (LLM, conf=0.90)
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“However, these studies included women with histories of both early and mid-pregnancy losses.48–52”
§ EULAR recommendations for the management of antiphospholipid syndrome in adults > RECOMMENDATIONS > Obstetric APS
What the sources say
- Not checked — no full text of the sourcecites [48] Muñoz-Rodriguez, 1999, Clinical study and follow-up of 100 patients with the antiphospholipid syndrome, Semin Arthritis Rheum source
- Supportedcites [49] Naru, 2010, Pregnancy outcome in women with antiphospholipid syndrome on low-dose aspirin and heparin: a retrospective study, East Mediterr Health J source
The Results section reports that the study included 64 women with recurrent miscarriage and compared their numbers of previous first-, second-, and third-trimester pregnancy losses. This supports the claim that the study included histories of both early and mid-pregnancy loss. No page number is available in our copy. (LLM, conf=0.90)
- Not checked — no full text of the sourcecites [50] Cohn, 2010, Recurrent miscarriage and antiphospholipid antibodies: prognosis of subsequent pregnancy, J Thromb Haemost source
- Supportedcites [51] Mohamed, 2014, Enoxaparin and aspirin therapy for recurrent pregnancy loss due to anti-phospholipid syndrome (APS), Middle East Fertil Soc J source
The Pregnancy morbidity criteria (section 2.1.2; page unavailable) include prior abortions before 10 weeks and fetal deaths at or after 10 weeks. Table 1 (section 6, Recommendation; page unavailable) records both prior abortions and prior intrauterine fetal deaths among the study participants, supporting the claim that the study included histories of early and later pregnancy loss. (LLM, conf=0.86)
- Not checked — no full text of the sourcecites [52] Ruffatti, 2014, Treatment strategies and pregnancy outcomes in antiphospholipid syndrome patients with thrombosis and triple antiphospholipid positivity. a European multicentre retrospective study, Thromb Haemost source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“For women with a history of fetal loss, combination treatment with LDA and heparin was associated with a higher likelihood of live birth compared with treatment with LDA alone.”
§ EULAR recommendations for the management of antiphospholipid syndrome in adults > RECOMMENDATIONS > Obstetric APS
What the sources say
- Not checked — no full text of the sourcecites [48] Muñoz-Rodriguez, 1999, Clinical study and follow-up of 100 patients with the antiphospholipid syndrome, Semin Arthritis Rheum source
- Partly supportedcites [49] Naru, 2010, Pregnancy outcome in women with antiphospholipid syndrome on low-dose aspirin and heparin: a retrospective study, East Mediterr Health J sourceExperimental — accuracy not yet measured
The Introduction and Discussion (pages unavailable in our copy) report two trials in aPL-positive women with recurrent miscarriage that found higher live-birth rates with aspirin plus heparin than with aspirin alone. But the cited paper’s own retrospective study concludes that the treatments were equally efficacious. The claim also omits the APS/aPL and recurrent-loss qualifications on the women studied. (LLM, conf=0.86)
- Not checked — no full text of the sourcecites [50] Cohn, 2010, Recurrent miscarriage and antiphospholipid antibodies: prognosis of subsequent pregnancy, J Thromb Haemost source
- Partly supportedcites [51] Mohamed, 2014, Enoxaparin and aspirin therapy for recurrent pregnancy loss due to anti-phospholipid syndrome (APS), Middle East Fertil Soc J sourceExperimental — accuracy not yet measured
The Results (section 3; page not provided) report more live births with low-dose aspirin plus LMWH than with aspirin alone (91% versus 65%; p = 0.02). However, the study included women with antiphospholipid syndrome and recurrent pregnancy loss; it does not establish the comparison for women with a history of fetal loss generally. (LLM, conf=0.86)
- Not checked — no full text of the sourcecites [52] Ruffatti, 2014, Treatment strategies and pregnancy outcomes in antiphospholipid syndrome patients with thrombosis and triple antiphospholipid positivity. a European multicentre retrospective study, Thromb Haemost source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“Because a history of thrombotic APS is associated with increased risk for future thrombotic or obstetric events,65 treatment with LDA and heparin at therapeutic dosage during pregnancy is recommended.”
§ EULAR recommendations for the management of antiphospholipid syndrome in adults > RECOMMENDATIONS > Obstetric APS
What the sources say
- Could not verifycites [65] de Jesús, 2019, Factors associated with first thrombosis in patients presenting with obstetric antiphospholipid syndrome (APS) in the APS Alliance for clinical trials and international networking clinical database and Repository: a retrospective study, BJOG sourceExperimental — accuracy not yet measured
The Results state that women whose thrombosis preceded obstetric APS were excluded from the analysis. The Discussion (Main Findings) instead examines first thrombosis after pregnancy morbidity; our copy does not assess whether a history of thrombotic APS increases the risk of later thrombotic or obstetric events. (LLM, conf=0.78)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Could not verify
- It may state two separate claims as one. 15
- Probably not a substantial claim. 8
- The quote only partly states this claim. 2
Some cited sources support this claim and some don’t — read each source’s verdict below.
In the paper
“Use of IVIG was not associated with a higher proportion of live births compared with conventional treatment in three small observational studies58–60 that directly addressed this question, although confounding by indication may have occurred.”
§ EULAR recommendations for the management of antiphospholipid syndrome in adults > RECOMMENDATIONS > Obstetric APS
What the sources say
- Not checked — no full text of the sourcecites [58] Diejomaoh, 2002, A favorable outcome of pregnancies in women with primary and secondary recurrent pregnancy loss associated with antiphospholipid syndrome, Arch Gynecol Obstet source
- Supportedcites [59] Jeremic, 2005, Comparison of two therapeutic protocols in patients with antiphospholipid Antibodies and recurrent miscarriages, Vojnosanit Pregl source
The Methods describe a 40-patient comparison of aspirin and heparin with or without IVIG. The Results report gestational success of 18/20 versus 17/20, with no statistically significant difference in pregnancy outcome (p > 0.05). This supports the cited study’s contribution to the claim; the possible confounding is a caution, not a finding the paper establishes. (LLM, conf=0.87)
- Disputedcites [60] Heilmann, 2008, Pregnancy outcome in women with antiphospholipid antibodies: report on a retrospective study, Semin Thromb Hemost sourceExperimental — accuracy not yet measured
The Abstract reports a higher observed proportion of live births with added IVIG than with standard therapy (83.7% versus 74.3%), contrary to the claim as worded. The Patients section supports the concern about confounding by indication: IVIG was given to women whose standard treatment had failed. The paper does not establish whether the live-birth difference was statistically significant. (LLM, conf=0.78)
Checked by a reasoning model — may be wrong.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Patients with APS with arterial thrombosis have a higher risk of recurrence compared with those with venous thrombosis, and a tendency for recurrences in the same vascular (arterial) bed.34”
§ EULAR recommendations for the management of antiphospholipid syndrome in adults > RECOMMENDATIONS > Secondary thromboprophylaxis in APS
What the sources say
- Partly supportedcites [34] Tektonidou, 2000, Prognostic factors and clustering of serious clinical outcomes in antiphospholipid syndrome, QJM sourceExperimental — accuracy not yet measured
The ‘Clustering of similar clinical events’ section reports a tendency for subsequent thromboses to occur in the same vascular bed as the presenting thrombosis. It does not establish that patients presenting with arterial thrombosis have a higher overall recurrence risk than those presenting with venous thrombosis; its odds ratios measure same-type clustering against other presentations, not arterial-versus-venous recurrence risk. Page numbers were not supplied in our copy. (LLM, conf=0.88)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“We followed the updated European League Against Rheumatism (EULAR) standardised operating procedure5 and used the Appraisal of Guidelines for Research & Evaluation II tool.6”
§ EULAR recommendations for the management of antiphospholipid syndrome in adults > METHODS
What the sources say
- Supportedcites [5] van der Heijde, 2015, 2014 update of the EULAR standardised operating procedures for EULAR-endorsed recommendations, Ann Rheum Dis source
Citation 5 identifies the updated EULAR standardised operating procedure, which is the cited paper itself. The paper’s “Evaluation of the recommendations” section also describes AGREE II, although the citing sentence assigns that tool its own citation (6). (LLM, conf=0.93)
- Supportedcites [6] Brouwers, 2010, Agree II: advancing Guideline Development, reporting and evaluation in health care, CMAJ source
Citation 6 is attached to the AGREE II tool, not to the EULAR procedure. The Abstract identifies AGREE II as the Appraisal of Guidelines, Research and Evaluation instrument, and “Using AGREE II” describes its use for guideline assessment. Page numbers are not provided in our copy. (LLM, conf=0.94)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“In one trial that provided data specifically on patients with arterial thrombosis, there was no difference in recurrences between those treated to a target INR of 2–3 or INR of 3–4 but without statistical significance (HR 3.1 (0.3–30.0)), although the sample was small and the achievement of a target INR of 3–4 was low.21”
§ EULAR recommendations for the management of antiphospholipid syndrome in adults > RECOMMENDATIONS > Secondary thromboprophylaxis in APS
What the sources say
- Supportedcites [21] Crowther, 2003, A comparison of two intensities of warfarin for the prevention of recurrent thrombosis in patients with the antiphospholipid antibody syndrome, N Engl J Med source
Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Data from one placebo-controlled RCT of LDA in six women with SLE42 and data from three low-quality studies (two RCTs, one retrospective cohort)43–45 of women without SLE found no difference in the prevalence of live births with use of LDA.”
§ EULAR recommendations for the management of antiphospholipid syndrome in adults > RECOMMENDATIONS > Obstetric APS
What the sources say
- Not checked — no full text of the sourcecites [42] Kaaja, 1993, Production of prostacyclin and thromboxane in lupus pregnancies: effect of Small dose of aspirin, Obstet Gynecol source
- Not checked — no full text of the sourcecites [43] Cowchock, 1997, Do low-risk pregnant women with antiphospholipid antibodies need to be treated? organizing group of the antiphospholipid antibody treatment trial, Am J Obstet Gynecol source
- Not checked — no full text of the sourcecites [44] Kahwa, 2006, Anticardiolipin antibodies in Jamaican primiparae, J Obstet Gynaecol source
- Partly supportedcites [45] Del Ross, 2013, Treatment of 139 pregnancies in antiphospholipid-positive women not fulfilling criteria for antiphospholipid syndrome: a retrospective study, J Rheumatol sourceExperimental — accuracy not yet measured
The Results report no statistically significant difference in pregnancy loss between the LDA and non-LDA groups, supporting the live-birth finding for this retrospective study. But the Results also identify three participants with SLE, so the study was not exclusively of women without SLE; the Discussion says its results cannot be extended to SLE. The RCTs in the citing sentence are attributed to other references, not this paper. (LLM, conf=0.86)
plainn = 6- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
Every source the paper cites for this claim was checked and supports it.
In the paper
“An early study in older patients with strokes reported no difference in event recurrences between LDA and warfarin, but aPL was tested only once and was mainly of low titre in this study.33”
§ EULAR recommendations for the management of antiphospholipid syndrome in adults > RECOMMENDATIONS > Secondary thromboprophylaxis in APS
What the sources say
- Supportedcites [33] Levine, 2004, Antiphospholipid Antibodies and subsequent thrombo-occlusive events in patients with ischemic stroke, JAMA source
The COMMENT section reports that warfarin was not associated with fewer subsequent thrombo-occlusive events than aspirin. It also states that aPL positivity was determined from one measurement and that most anticardiolipin immunoreactivity was low-positive. The study used aspirin 325 mg/day; the RESULTS section gives ages averaging about 62–63 years in the aspirin group. (LLM, conf=0.90)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
In the paper
“Treatment with LDA for patients with SLE and high-risk aPL profile is supported by a subanalysis of eight studies, mostly observational, in a meta-analysis.14 In this analysis, risk of first thrombosis was reduced by almost half among patients treated with LDA versus patients not treated, without major bleeding events.”
§ EULAR recommendations for the management of antiphospholipid syndrome in adults > RECOMMENDATIONS > Primary thromboprophylaxis in aPL-positive subjects
What the sources say
- Not checked — no full text of the sourcecites [14] Arnaud, 2014, Efficacy of aspirin for the primary prevention of thrombosis in patients with antiphospholipid antibodies: an international and collaborative meta-analysis, Autoimmun Rev source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“An earlier SLR including mainly observational studies reported that recurrent events occurred more often in patients with APS treated with VKA with a target INR of 2–3 compared with an INR of 3–4, but outcomes among patients with first arterial thrombosis were not analysed specifically.35”
§ EULAR recommendations for the management of antiphospholipid syndrome in adults > RECOMMENDATIONS > Secondary thromboprophylaxis in APS
What the sources say
- Not checked — no full text of the sourcecites [35] Ruiz-Irastorza, 2007, A systematic review of secondary thromboprophylaxis in patients with antiphospholipid antibodies, Arthritis Rheum source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“However, evidence is limited by the frequent failure to achieve the target INR in the high-intensity groups in the RCTs.”
§ EULAR recommendations for the management of antiphospholipid syndrome in adults > RECOMMENDATIONS > Secondary thromboprophylaxis in APS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The quote only partly states this claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Data on bleeding were not reported for patients with venous thrombosis specifically.”
§ EULAR recommendations for the management of antiphospholipid syndrome in adults > RECOMMENDATIONS > Secondary thromboprophylaxis in APS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Rests on an assumption: A higher level of anticoagulation is expected to carry a higher risk of bleeding.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“The presence of aPL in asymptomatic individuals or patients with SLE does not confirm the diagnosis of APS but can be associated with increased risk of thrombosis or pregnancy morbidity, depending on aPL characteristics and coexistence of other risk factors.3 4”
§ EULAR recommendations for the management of antiphospholipid syndrome in adults > INTRODUCTION
What the sources say
- Not checked — no full text of the sourcecites [3] Ruiz-Irastorza, 2011, Evidence-based recommendations for the prevention and long-term management of thrombosis in antiphospholipid antibody-positive patients: report of a task Force at the 13th International Congress on antiphospholipid antibodies, Lupus source
- Not checked — no full text of the sourcecites [4] Garcia, 2018, Diagnosis and management of the antiphospholipid syndrome, N Engl J Med source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“However, these studies included a mixture of patients with either venous or arterial thrombosis, and a minority had arterial events.”
§ EULAR recommendations for the management of antiphospholipid syndrome in adults > RECOMMENDATIONS > Secondary thromboprophylaxis in APS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“All titles and abstracts of retrieved articles were first reviewed independently by the two literature reviewers. The full-text articles were then reviewed independently by three persons: one literature reviewer, convenor and methodologist.”
§ EULAR recommendations for the management of antiphospholipid syndrome in adults > METHODS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“This review did not compare the target INR 2–3 and INR 3–4 arms within the same study, but disaggregated the arms.”
§ EULAR recommendations for the management of antiphospholipid syndrome in adults > RECOMMENDATIONS > Secondary thromboprophylaxis in APS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Each included article was graded for its methodological quality and assigned to the relevant PICO question by the convenor and methodologist.”
§ EULAR recommendations for the management of antiphospholipid syndrome in adults > METHODS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Because studies combined several types of pregnancy losses without specifying on the proportion of ‘non-criteria’ APS and due to very limited evidence, this recommendation is mainly based on expert opinion.”
§ EULAR recommendations for the management of antiphospholipid syndrome in adults > RECOMMENDATIONS > Obstetric APS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“was sent by the convenor to all task force members, who voted anonymously on the level of agreement (LoA). A rating scale of 0–10 (0: do not agree; 10: fully agree) was used for each recommendation.”
§ EULAR recommendations for the management of antiphospholipid syndrome in adults > METHODS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Data from two studies (one RCT, one retrospective cohort)48 55 showed that the likelihood of live births did not differ between women treated with LDA plus heparin and those treated with LDA alone.”
§ EULAR recommendations for the management of antiphospholipid syndrome in adults > RECOMMENDATIONS > Obstetric APS
What the sources say
- Not checked — no full text of the sourcecites [48] Muñoz-Rodriguez, 1999, Clinical study and follow-up of 100 patients with the antiphospholipid syndrome, Semin Arthritis Rheum source
- Not checked — no full text of the sourcecites [55] van Hoorn, 2016, Low-molecular-weight heparin and aspirin in the prevention of recurrent early-onset pre-eclampsia in women with antiphospholipid antibodies: the FRUIT-RCT, Eur J Obstet Gynecol Reprod Biol source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The quote only partly states this claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The data abstraction was performed by the two literature reviewers according to a written protocol and supervised by the methodologist. Data abstraction was then independently double-checked by the convenor and methodologist.”
§ EULAR recommendations for the management of antiphospholipid syndrome in adults > METHODS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The task force included members from several professional groups covering different perspectives and also involved two patients who participated actively in both meetings.”
§ EULAR recommendations for the management of antiphospholipid syndrome in adults > DISCUSSION
plainn = 2- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper relies on this without support.
A higher level of anticoagulation is expected to carry a higher risk of bleeding.
“However, although not based on data from these studies, higher level of anticoagulation would be anticipated to also have a higher risk of bleeding.”
The paper relies on this without support.
For antiphospholipid syndrome patients with provoked first venous thrombosis, the anticoagulation duration recommended for patients without antiphospholipid syndrome is appropriate.
“The panel recommended a duration of anticoagulation according to international guidelines for patients without APS30 because the benefit of long-term anticoagulation in this population is unclear.”
The paper relies on this without support.
Low-dose aspirin has a low risk of adverse events in asymptomatic antiphospholipid antibody carriers.
“given the likelihood of benefit and low risk of adverse events of this intervention.”
The paper relies on this without support.
High-risk aPL profile is associated with risk of obstetric and thrombotic complications during pregnancy.
“The panel agreed that use of LDA should be considered in pregnant women with high-risk aPL profile due to the risk of obstetric and thrombotic complications during pregnancy associated with high-risk aPL profile.”
The paper relies on this without support.
Women with a history of clinical non-criteria obstetric APS have a potential higher risk for obstetric and/or thrombotic complications during pregnancy.
“Because of a potential higher risk for obstetric and/or thrombotic complications during pregnancy in women with a history of clinical ‘non-criteria’ obstetric APS, the panel agreed that treatment with LDA alone or in combination with heparin might be considered, based on an individual’s risk profile (aPL profile, concomitant SLE, prior live births, and additional risk factors for pregnancy loss or”
The paper relies on this without support.
There is an increased risk of thrombosis at puerperium.
“The panel suggested that in women receiving prophylactic dose heparin during pregnancy, the same dosage of heparin should be continued for 6 weeks after delivery due to an increased risk of thrombosis at puerperium.”
The paper relies on this without support.
The most common practice when LDA plus prophylactic heparin fails is to increase heparin dose to therapeutic dose.
“The most common practice if the combination of LDA and prophylactic dose heparin fails is to increase the dose of heparin to therapeutic dose, although no supporting evidence exists.”
The paper relies on this without support.
Cost and availability of suggested treatments are not a barrier to implementation, except IVIG and plasmapheresis.
“The cost and availability of suggested treatments are not a barrier to implementation of these recommendations, with the exception of IVIG and plasmapheresis.”
The paper relies on this without support.
CAPS occurs in less than 1% of patients.
“However, both treatments were recommended as first-line treatment only in CAPS which occurs in less than 1% of patients, while B cell depletion and complement inhibitors may be considered in refractory cases of CAPS.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ EULAR recommendations for the management of antiphospholipid syndrome in adults > RECOMMENDATIONS > Obstetric APS
“Pooled data from one RCT including only patients with a history of first trimester losses46 and eight supporting observational studies47–54”
§ EULAR recommendations for the management of antiphospholipid syndrome in adults > References
“54. Laskin CA, Spitzer KA, Clark CA, Low molecular weight heparin and aspirin for recurrent pregnancy loss: results from the randomized, controlled HepASA trial.”
Citations
Cites
MIYAKIS, S., LOCKSHIN, M. D., ATSUMI, T., BRANCH, D. W., BREY, R. L., CERVERA, R., DERKSEN, R. H. W. M., DE GROOT, P. G., KOIKE, T., MERONI, P. L., et al. (2006) · Journal of Thrombosis and Haemostasis · doi:10.1111/j.1538-7836.2006.01753.x · Cited by 7,203
Self-citationAntithrombotic Therapy for VTE Disease
Kearon, C., Akl, E. A., Ornelas, J., Blaivas, A., Jimenez, D., Bounameaux, H., Huisman, M., King, C. S., Morris, T. A., Sood, N., et al. (2016) · Chest · doi:10.1016/j.chest.2015.11.026 · Cited by 4,830 · cited 1×
“The panel recommended a duration of anticoagulation according to international guidelines for patients without APS 30 because the benefit of long-term anticoagulation in this population is unclear.”
AGREE II: advancing guideline development, reporting and evaluation in health care
Brouwers, M. C., Kho, M. E., Browman, G. P., Burgers, J. S., Cluzeau, F., Feder, G., Fervers, B., Graham, I. D., Grimshaw, J., Hanna, S. E., et al. (2010) · Canadian Medical Association Journal · doi:10.1503/cmaj.090449 · Cited by 3,790
The management of thrombosis in the antiphospholipid-antibody syndrome
Khamashta, M. A., Cuadrado, M. J., Mujic, F., Taub, N. A., Hunt, B. J., & Hughes, G. R. V. (1995) · New England Journal of Medicine · doi:10.1056/nejm199504133321504 · Cited by 1,450 · cited 1×
“33 These issues make it difficult to apply the latter results to patients of any age who fulfil the laboratory criteria for APS.”
Self-citationRai, R., Cohen, H., Dave, M., & Regan, L. (1997) · BMJ · doi:10.1136/bmj.314.7076.253 · Cited by 1,113
Cervera, R., Serrano, R., Pons-Estel, G. J., Ceberio-Hualde, L., Shoenfeld, Y., de Ramón, E., Buonaiuto, V, Jacobsen, S., Zeher, M. M., Tarr, T., et al. (2015) · Annals of the Rheumatic Diseases · doi:10.1136/annrheumdis-2013-204838 · Cited by 974
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Rivaroxaban vs warfarin in high-risk patients with antiphospholipid syndrome
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“7”
Self-citationDiagnosis and management of the antiphospholipid syndrome
Garcia, D., & Erkan, D. (2018) · New England Journal of Medicine · doi:10.1056/nejmra1705454 · Cited by 819
Research works printed but not linked: 1
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Cited by
Sorted by citations
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Smith‐Jackson, K., & Harrison, R. A. (2022) · Immunological Reviews · doi:10.1111/imr.13169 · Cited by 22
“163 In a large European Registry study, the outcomes of pregnancies in 1000 women were analyzed.”
BackgroundAnticoagulation for the Prevention of Arterial Thrombosis in Ambulatory Cancer Patients
Xu, Y., Cole, K. M., Collins, É., Moledina, A., Mallity, C., & Carrier, M. (2023) · JACC CardioOncology · doi:10.1016/j.jaccao.2023.04.003 · Cited by 21
Ruiz‐Irastorza, G., Tektonidou, M. G., & Khamashta, M. A. (2024) · Rheumatology · doi:10.1093/rheumatology/kead538 · Cited by 22
Self-citationRadin, M., Cecchi, I., Schreiber, K. I., Rubini, E., Roccatello, D., Cuadrado, M. J., & Sciascia, S. (2020) · Seminars in Arthritis and Rheumatism · doi:10.1016/j.semarthrit.2020.01.007 · Cited by 20
“based on not controlled studies[7][21,20]and mainly relies on physicians’ judgment[22][23].”
BackgroundSelf-citationvan den Hoogen, L. L., & van Laar, J. M. (2020) · Best Practice & Research Clinical Rheumatology · doi:10.1016/j.berh.2020.101485 · Cited by 21
Hu, C., Li, S., Xie, Z., You, H., Jiang, H., Shi, Y., Qi, W., Zhao, J., Wang, Q., Tian, X., et al. (2021) · Frontiers in Immunology · doi:10.3389/fimmu.2021.648881 · Cited by 21
“According to the European League Against Rheumatism (EULAR) guidelines for APS, high-risk profiles for APS is defined as a positive LA test, the presence of double (any combination of LA, aCL or ab2GPI antibodies) or triple (all three subtypes) aPL positivity, or the presence of persistently high aPL titers (23).”
MethodBarrio-Longarela, S. D., Martínez-Taboada, V. M., Blanco-Olavarri, P., Merino, A., Riancho‐Zarrabeitia, L., Comins‐Boo, A., López‐Hoyos, M., & Hernández, J. L. (2021) · Clinical Reviews in Allergy & Immunology · doi:10.1007/s12016-021-08915-9 · Cited by 19
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Anticardiolipin and/or anti-β2-glycoprotein-I antibodies are associated with adverse IVF outcomes
Wu, L., Fang, X., Lu, F., Zhang, Y., Wang, Y., & Kwak-Kim, J. Y.-H. (2022) · Frontiers in Immunology · doi:10.3389/fimmu.2022.986893 · Cited by 19
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Self-citationCardiovascular Disease in Antiphospholipid Syndrome
Polytarchou, K., Varvarousis, D., & Manolis, A. S. (2019) · Current Vascular Pharmacology · doi:10.2174/1570161117666190830101341 · Cited by 19
Thrombotic microangiopathy in rheumatology: a link between thrombosis and autoimmunity
Nasonov, E. L., Reshetnyak, T. M., & Alekberova, Z. S. (2020) · Terapevticheskii arkhiv · doi:10.26442/00403660.2020.05.000697 · Cited by 19
Neutrophil glucose flux as a therapeutic target in antiphospholipid syndrome
Tambralli, A., Harbaugh, A., NaveenKumar, S. K., Radyk, M. D., Rysenga, C. E., Sabb, K., Hurley, J. M., Sule, G. J., Yalavarthi, S., Estes, S. K., et al. (2024) · Journal of Clinical Investigation · doi:10.1172/jci169893 · Cited by 18
“APS is best known for increasing the risk of thrombotic events and late-term pregnancy morbidity and is usually treated with lifelong anticoagulation (1, 3).”
BackgroundAntiphospholipid Syndrome: Insights into Molecular Mechanisms and Clinical Manifestations
Celia, A. I., Galli, M., Mancuso, S., Alessandri, C., Frati, G., Sciarretta, S., & Conti, F. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13144191 · Cited by 20
“For refractory cases of CAPS, B-cell depletion therapies (e.g., rituximab) or complement inhibition therapies (e.g., eculizumab) may be considered, based on the results of some case reports [56].”
BackgroundComplement activation in secondary thrombotic microangiopathies
Morelle, J., Caravaca‐Fontán, F., Fakhouri, F., Frangou, E. A., Bruchfeld, A. N., Floege, J., Mirioğlu, Ş., Moran, S. M., Steiger, S., Stevens, K., et al. (2025) · Nephrology Dialysis Transplantation · doi:10.1093/ndt/gfaf091 · Cited by 21
“The current therapeutic approach to catastrophic APS relies on a combination of systemic anticoagulation, corticosteroids, therapeutic plasma exchange and intravenous immunoglobulins [106 ].”
Obstetric anti-phospholipid syndrome: from pathogenesis to treatment
Kaneko, K., Ozawa, N., & Murashima, A. (2021) · Immunological Medicine · doi:10.1080/25785826.2021.1969116 · Cited by 18
“In 70–80% of patients with obstetric APS, outcomes of subsequent pregnancies can be improved with combination therapy with lowdose aspirin and LMWH or UFH.”
BackgroundInfluentialRiancho‐Zarrabeitia, L., López-Marín, L., Muñoz, P., López‐Hoyos, M., del Barrio, R., Haya, A., & Martínez-Taboada, V. M. (2022) · Lupus · doi:10.1177/09612033221091401 · Cited by 18
“31(7) 808–819 © The Author(s) 2022 Article reuse guidelines: sagepub.”
BackgroundInfluentialPanopoulos, S., Drosos, G. C., Konstantonis, G. D., Sfikakis, P. P., & Tektonidou, M. G. (2023) · Lupus Science & Medicine · doi:10.1136/lupus-2022-000864 · Cited by 19
Self-citationVandevelde, A., Gris, J., Moore, G. W., Musiał, J., Zuily, S., Wahl, D. G., & Devreese, K. M. J. (2023) · Journal of Thrombosis and Haemostasis · doi:10.1016/j.jtha.2023.04.001 · Cited by 19
Self-citationZuily, S., Cervera, R., Foret, T., et al. (2023) · Autoimmunity Reviews · doi:10.1016/j.autrev.2023.103417 · Cited by 18
Self-citationLiu, T., Han, J., Zhang, R., Tang, Z., Yi, G., Gong, W., Wan, L., Hu, Q., Teng, J., Liu, H., et al. (2021) · Lara D. Veeken · doi:10.1093/rheumatology/keab416 · Cited by 18
Bettiol, A., Emmi, G., Finocchi, M., Silvestri, E., Urban, M. L., Mattioli, I., Scalera, A., Lupoli, R., Vannacci, A., Minno, M. N. D. D., et al. (2020) · Rheumatology · doi:10.1093/rheumatology/keaa116 · Cited by 18
Correspondence on ‘2023 ACR/EULAR antiphospholipid syndrome classification criteria’
Tang, Z., Shi, H., Liu, H.-L., Cheng, X., Ye, J., Su, Y., Hu, Q., Meng, J., Pan, H., Yang, C., et al. (2023) · Annals of the Rheumatic Diseases · doi:10.1136/ard-2023-225013 · Cited by 19
Kupferminc, M. J., Kliger, C., Rimon, E., Ascher-Landsberg, J., Skornick‐Rapaport, A., Gamzu, R., & Yogev, Y. (2021) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2021.1940940 · Cited by 18
“except of 6 women with APS who were already treated with LDA prior to pregnancy [33].”
BackgroundZhang, J., Li, C., Han, X., Chen, Z., Adhikari, B. K., Wang, Y., Wang, Y., & Sun, J. (2021) · Annals of Medicine · doi:10.1080/07853890.2021.1962964 · Cited by 18
“after evaluating potential causes, an increase of target INR to 3-4or addition of LDA or switch to LMWH can be considered [114].”
BackgroundInfluentialHoxha, A., Tormene, D., Campello, E., & Simioni, P. (2022) · Frontiers in Pharmacology · doi:10.3389/fphar.2022.849692 · Cited by 17
“Currently, the European League Against Rheumatism (EULAR) guidelines for the management of APS recommends heparin with low-dose aspirin (LDA) as the standard of care (SoC) to prevent pregnancy loss (Tektonidou et al., 2019), even though the evidence is of low certainty (Hamulyák et al.”
BackgroundThrombosis and Anticoagulation Therapy in Systemic Lupus Erythematosus
Yuan, W.-J., & Guan, F. (2022) · Autoimmune Diseases · doi:10.1155/2022/3208037 · Cited by 20
Differentiating and Managing Rare Thrombotic Microangiopathies During Pregnancy and Postpartum
Lim, M. Y., Abou‐Ismail, M. Y., & Branch, D. W. (2022) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000005024 · Cited by 17
The pathogenesis of obstetric APS: a 2023 update
Mineo, C., Shaul, P. W., & Bermas, B. L. (2023) · Clinical Immunology · doi:10.1016/j.clim.2023.109745 · Cited by 24
Can complement activation be the missing link in antiphospholipid syndrome?
Venturelli, V., Maranini, B., Tohidi‐Esfahani, I., Isenberg, D. A., Cohen, H., & Efthymiou, M. (2024) · Lara D. Veeken · doi:10.1093/rheumatology/keae178 · Cited by 17
Bortoluzzi, A., Andréoli, L., Carrara, G., et al. (2020) · Arthritis Care & Research · doi:10.1002/acr.24116 · Cited by 17
“imply a suboptimal risk stratification (5,20,21).”
BackgroundMethodSelf-citationKim, J. W., Kim, T. W., Ryu, K. H., Park, S. G., Jeong, C. Y., & Park, D. H. (2020) · Journal of International Medical Research · doi:10.1177/0300060519896889 · Cited by 17
“In addition, a prophylactic dose of low-molecularweight heparin (LMWH) is considered in high-risk situations such as surgery, prolonged immobilization, and the puerperium.(17,30) Secondary thromboprophylaxis is used for patients with a history of venous or arterial thrombosis.”
BackgroundLuo, T., Wang, Z., Chen, Z., et al. (2021) · Quantitative Imaging in Medicine and Surgery · doi:10.21037/qims-20-859 · Cited by 17
Towards precision medicine in antiphospholipid syndrome
López-Pedrera, C., Pérez-Sánchez, C., & Tektonidou, M. G. (2025) · The Lancet Rheumatology · doi:10.1016/s2665-9913(25)00094-3 · Cited by 18
Self-citationMaternal and foetal placental vascular malperfusion in pregnancies with anti-phospholipid antibodies
Spinillo, A., Bellingeri, C., Cavagnoli, C., Maggio, I. D., Riceputi, G., Ruspini, B., Cesari, S., & Beneventi, F. (2020) · Lara D. Veeken · doi:10.1093/rheumatology/keaa499 · Cited by 16
Adverse Reaction to COVID-19 mRNA Vaccination in a Patient With VEXAS Syndrome
Ciprian, G. (2022) · Cureus · doi:10.7759/cureus.23456 · Cited by 16
“In these cases, it is acceptable to continue with DOAC alone unless complications arise, such as failure to respond to treatment [10-12].”
BackgroundMoschetti, L., Pozzolo, L. D., Guern, V. L., Morel, N., Yelnik, C., Lambert, M., HACHULLA, E., Benhamou, Y., Nalli, C., Fredi, M., et al. (2022) · Clinical and Experimental Rheumatology · doi:10.55563/clinexprheumatol/9royri · Cited by 16
“risk situations (surgery, prolonged immobilisation, puerperium) and should always carefully evaluated (29).”
BackgroundInfluentialSelf-citationNoordermeer, T., Urbanus, R. T., Wong, C. Y., et al. (2023) · Research and Practice in Thrombosis and Haemostasis · doi:10.1016/j.rpth.2022.100011 · Cited by 16
“Vitamin K antagonists (VKAs) are commonly used for secondary prophylaxis [5].”
BackgroundSelf-citationHisada, R., & Atsumi, T. (2023) · Biomolecules · doi:10.3390/biom13040617 · Cited by 18
“Combination therapy with HCQ or statins may also be considered [72].”
BackgroundMethodInfluentialRojas-Rivera, J. E., García-Carro, C., Ávila, A. I., Espino, M., Espinosa, M., Juarez, G. M. F., Fulladosa, X., Goicoechea, M., Macia, M. L., Morales, E., et al. (2023) · Nefrología (English Edition) · doi:10.1016/j.nefroe.2023.05.006 · Cited by 18
Risk Factors for Antiphospholipid Antibodies and Antiphospholipid Syndrome
Aguirre-del-Pino, R., Monahan, R. C., Huizinga, T. W. J., Eikenboom, J. C. J., & Steup‐Beekman, G. M. (2024) · Seminars in Thrombosis and Hemostasis · doi:10.1055/s-0043-1776910 · Cited by 21
“30 It isfundamental to remember that classi fi cation criteria are developed for research purposes.”
InfluentialPengo, V. (2020) · Journal of Thrombosis and Haemostasis · doi:10.1111/jth.15026 · Cited by 16
Self-citationFarkh, C., Ellouze, S., Gounelle, L., Sad Houari, M., Duchemin, J., Proulle, V., Fontenay, M., Delavenne, X., & Jourdi, G. (2021) · Frontiers in Medicine · doi:10.3389/fmed.2021.683357 · Cited by 16
“ISTH, EULAR, and BSH recommended against their use also in APS patients with a history of arterial thrombosis (8, 9).”
Barilaro, G., Esteves, A., Rocca, C. D., Pérez-Isidro, A., Araújo, O., da Rosa, G. P., Ruiz‐Ortiz, E., Penella, D. T., Viñas, O., Reverter, J. C., et al. (2022) · Rheumatology · doi:10.1093/rheumatology/keac485 · Cited by 14
Self-citationFlessa, C., Vlachiotis, S., Nezos, A., et al. (2019) · Clinical Immunology · doi:10.1016/j.clim.2019.108265 · Cited by 16
Self-citationManagement of Pregnancy in Lupus
Moyer, A., & Chakravarty, E. F. (2021) · Rheumatic Disease Clinics of North America · doi:10.1016/j.rdc.2021.04.008 · Cited by 16
Cimolai, N. (2021) · SN Comprehensive Clinical Medicine · doi:10.1007/s42399-021-00992-3 · Cited by 15
“Indeed the plethora of publications on this topic varies greatly in the application of diagnostic antibody thresholds whether for frank disease or for population screening studies [22].”
BackgroundInfluentialProgress of oxidative stress in endometrium decidualization
Gao, W., Feng, F., Ma, X., et al. (2022) · Journal of Obstetrics and Gynaecology · doi:10.1080/01443615.2022.2144171 · Cited by 15
“Previous studies have shown that in addition to anticoagulation and antithrombosis, it also plays a role in regulating reproductive immunity (Tektonidou et al. 2019), promoting trophoblast proliferation (Chen et al. 2012) and improving endometrial receptivity (Spratte et al. 2016).”
BackgroundSystemic lupus erythematosus and antiphospholipid syndrome: past, present, future
Nasonov, E. L., Reshetnyak, T. M., Solovyev, S. K., & Попкова, Т. В. (2023) · Terapevticheskii arkhiv · doi:10.26442/00403660.2023.05.202246 · Cited by 15
“Сложность лечения АФС связана с неоднородностью патогенетических механизмов, лежащих в основе тромбозов (аутоимммунные и/или воспалительные), полиморфизмом клинических проявлений, отсутствием достоверных клинических и лабораторных показателей, позволяющих прогнозировать риск рецидивирования тромбозов [93].”
Ding, Z., Pan, H., Yang, Z., Yang, C., & Shi, H. (2023) · Clinical Immunology · doi:10.1016/j.clim.2023.109804 · Cited by 16
The impact of antiphospholipid antibodies/antiphospholipid syndrome on systemic lupus erythematosus
Venturelli, V., Abrantes, A. M., Rahman, A., & Isenberg, D. A. (2024) · Rheumatology · doi:10.1093/rheumatology/kead618 · Cited by 17
Management of antiphospholipid syndrome
Rahman, A. (2020) · Clinical Rheumatology · doi:10.1007/s10067-020-05183-4 · Cited by 18
Kuipers, R. S., Berghuis, M. A. T., Ogilvie, A. C., et al. (2021) · European Heart Journal - Case Reports · doi:10.1093/ehjcr/ytab120 · Cited by 15
“Libman–Sacks) NBTE, vitamin K antagonists are the anticoagulant of choice, and DOACs are generally not recommended.(25) With regard to long-term management, surgery, including valve repair and vegetation excision, has been described for 18% of patients with and 28% of patients without malignancy in a single centre aft…”
BackgroundGao, R., Zeng, X., & Qin, L. (2021) · Chinese Medical Journal · doi:10.1097/cm9.0000000000001691 · Cited by 15
“Systemic autoimmune diseases like antiphospholipid syndrome (APS),([3]) undifferentiated connective tissue disease (UCTD),([4]) and systemic lupus erythematosus (SLE)([5]) have been found to be important causes of RPL in recent years.”
BackgroundMethodInfluentialGao, R., Deng, W., Cheng, M., et al. (2021) · Lupus · doi:10.1177/09612033211055816 · Cited by 15
“For pregnancy with SLE and refractory antiphospholipid syndrome (RAPS), HCQ was recommended throughout pregnancy because of the function of immune regulation and anti-inflammatory.(17,18) However, the effect of HCQ on the IVF/ICSI outcomes for ANA-positive women was little explored, especially in frozen embryo transfe…”
BackgroundThe assessment of patients with the antiphospholipid antibody syndrome: where are we now?
Gaspar, P., Cohen, H., & Isenberg, D. A. (2020) · Lara D. Veeken · doi:10.1093/rheumatology/keaa172 · Cited by 15
Jin, J., Xu, X., Hou, L., Hou, Y., Li, J., Liang, M.-Y., & Li, C. (2022) · Frontiers in Immunology · doi:10.3389/fimmu.2022.971005 · Cited by 14
“02 However, OAPS differ from ITP since these patients have hypercoagulability with thrombocytopenia.”
BackgroundInfluentialPappa, M. B., Ntouros, P. A., Papanikolaou, C., Sfikakis, P. P., Souliotis, V. L., & Tektonidou, M. G. (2023) · Clinical Immunology · doi:10.1016/j.clim.2023.109693 · Cited by 14
Self-citationAntiphospholipid Syndrome: State of the Art of Clinical Management
Depietri, L., Veropalumbo, M. R., Leone, M. C., & Ghirarduzzi, A. (2023) · Cardiovascular Drugs and Therapy · doi:10.1007/s10557-023-07496-3 · Cited by 16
“The European League Against Rheumatism (EULAR) guidelines suggest low-dose aspirin for primary prophylaxis in patients with a high-risk aPL profile who do not meet clinical criteria for APS, patients with SLE and high-risk aPL profile and non-pregnant women with a history of obstetric APS only [44].”
Tian, X., Zhao, J., Song, Y., Wang, Q., Li, M., Liu, J., & Zeng, X. (2023) · Rheumatology and Immunology Research · doi:10.2478/rir-2023-0019 · Cited by 14
II Brazilian Society of Rheumatology consensus for lupus nephritis diagnosis and treatment
dos Reis-Neto, E. T., Seguro, L. P. C., Sato, E. I., Borba, E. F., Klumb, E. M., Costallat, L. T. L., Medeiros, M. M. D. C., Bonfá, E., Araújo, N. C., Appenzeller, S., et al. (2024) · Revista Brasileira de Reumatologia · doi:10.1186/s42358-024-00386-8 · Cited by 21
“In the case of APS, treatment should follow specific guidelines according to clinical phenotype [138].”
MethodNasonov, E. L., Rumyantsev, A. G., & MIu, S. (2024) · Rheumatology Science and Practice · doi:10.47360/1995-4484-2024-262-279 · Cited by 14
Central Nervous System Involvement in Systemic Autoimmune Rheumatic Diseases—Diagnosis and Treatment
Juncker, A., Appenzeller, S., & de Souza, J. M. (2024) · Pharmaceuticals · doi:10.3390/ph17081044 · Cited by 14
“As most NPSLE patients are positive for aPL, consideration should be given to low-dose aspirin or warfarin in these cases [29,31].”
BackgroundMartínez-Taboada, V. M., Gómez, A. M., Barrio-Longarela, S. D., Merino, A., Comins‐Boo, A., López‐Hoyos, M., Riancho‐Zarrabeitia, L., Gálvez, R., & Hernández, J. L. (2024) · Diagnostics · doi:10.3390/diagnostics14192162 · Cited by 17
“REVIEW 6 of 15 After diagnosis, most of them received SoC treatment with LDA and/or LMWH during pregnancy [18–21] (Table 3).”
MethodHuang, C., Ding, Y., Chen, Z., Wu, L., Wei, W., Zhao, C., Yang, M., Lin, S., Wang, Q., Tian, X., et al. (2025) · BMC Medicine · doi:10.1186/s12916-024-03843-9 · Cited by 14
Management of anticoagulant-refractory thrombotic antiphospholipid syndrome
Cohen, H., Sayar, Z., Efthymiou, M., Gaspar, P., Richards, T., & Isenberg, D. A. (2020) · The Lancet Haematology · doi:10.1016/s2352-3026(20)30116-2 · Cited by 17
Why thromboembolism occurs in some patients with thrombocytopenia and treatment strategies
Han, X., Li, C., Zhang, S., Hou, X., Chen, Z., Zhang, J. C., Zhang, Y., Sun, J., & Wang, Y. (2020) · Thrombosis Research · doi:10.1016/j.thromres.2020.10.005 · Cited by 14
Tailored treatment strategies and future directions in systemic lupus erythematosus
Nikolopoulos, D., Fotis, L., Gioti, O., & Fanouriakis, A. (2022) · Rheumatology International · doi:10.1007/s00296-022-05133-0 · Cited by 14
“Updated EULAR recommendations for both APS and SLE emphasize the need for primary prevention in aPL carriers [9, 56].”
BackgroundInfluentialTesta, S., Meijer, P., Lasne, D., & Mullier, F. (2022) · International Journal of Laboratory Hematology · doi:10.1111/ijlh.13936 · Cited by 14
Wu, T., Huang, W., Qi, J., Li, Y., Zhang, Y., Jiang, H., Wang, J., Zhang, J., Jiang, Z.-Y., Chen, L., et al. (2022) · Frontiers in Pharmacology · doi:10.3389/fphar.2022.1035229 · Cited by 13
“In individuals with APS and a first onset of VTE, a VKA with an international normalized ratio (INR) aim of two to three is recommended (Tektonidou et al., 2019).”
BackgroundGan, Y., Zhong, X., Zhao, Y., Li, G., Ye, H., & Li, C. (2022) · Frontiers in Immunology · doi:10.3389/fimmu.2022.971366 · Cited by 13
“Age of onset/ gender aPL profile Types Anticoagulation therapy Non-criteria manifestations Initial induction therapy RTX dose (mg) Maintenance regimen Outcomes at 6 months 1 45/F ab2GPI, LAC SAPS No& Thrombocytopenia No 2000 Pre NR 2 72/F Triple positive SAPS Warfarin Thrombocytopenia Yes 800 Pre+HCQ CR 3 24/F Triple…”
BackgroundInfluentialShedding Light on the Pathogenesis of Splanchnic Vein Thrombosis
Camerlo, S., Ligato, J., Rosati, G., Carrà, G., Russo, I., Gobbi, M. D., & Morotti, A. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms24032262 · Cited by 12
“antiphospholipid antibodies in patients with new diagnosis of idiopathic SVT [26].”
BackgroundBouki, K., Venetsanaki, V., Chrysoulaki, M., Pateromichelaki, A., Betsi, G., Daraki, V. N., Sbyrakis, N., Spanakis, K., Bertsias, G. K., Sidiropoulos, P. I., et al. (2023) · HORMONES · doi:10.1007/s42000-023-00463-5 · Cited by 15
Antiphospholipid syndrome nephropathy: Current knowledge and unanswered questions
Xourgia, E., & Tektonidou, M. G. (2023) · Clinical Immunology · doi:10.1016/j.clim.2023.109735 · Cited by 13
Self-citationHow to diagnose and manage antiphospholipid syndrome
Hubben, A. K., & McCrae, K. R. (2023) · Hematology · doi:10.1182/hematology.2023000493 · Cited by 16
Obstetric antiphospholipid syndrome
Soto-Peleteiro, A., González-Echávarri, C., & Ruiz‐Irastorza, G. (2024) · Medicina Clínica · doi:10.1016/j.medcli.2024.05.001 · Cited by 15
Self-citationNeuropsychiatric manifestations in systemic lupus erythematosus and Sjogren's disease
Costa, A. G. S., Nunes, D. P. F., Júlio, P. R., Marchi-Silva, R., de Aquino, B. M., Andrade, S. D. O., Pereira, D. R., Mazzola, T. N., de Souza, J. M., Martinez, A. R. M., et al. (2025) · Autoimmunity Reviews · doi:10.1016/j.autrev.2025.103756 · Cited by 14
Molecular mechanisms underlying thrombosis in systemic lupus erythematosus – A Systematic review
Larsen, M. L., Nørgaard, L., Linge, P., Larsen, J. B., Langkilde, H. Z., Hauge, E., Thiel, S., Voss, A., Bengtsson, A. A., & Troldborg, A. (2025) · Seminars in Arthritis and Rheumatism · doi:10.1016/j.semarthrit.2025.152707 · Cited by 18
der DGRh, K. P., Fiehn, C., Ness, T., Weseloh, C., Specker, C., Hadjiski, D., Detert, J., & Krüger, K. (2020) · Zeitschrift für Rheumatologie · doi:10.1007/s00393-020-00751-0 · Cited by 13
Cutaneous manifestations of antiphospholipid syndrome
Gómez‐Flores, M., Herrera-Argaez, G., Vázquez‐Martínez, O., Herz‐Ruelas, M. E., Ocampo‐Candiani, J., Villarreal‐Martínez, A., Galarza-Delgado, D. Á., Hernandez-Galarza, I. D. J., & Chávez‐Álvarez, S. (2021) · Lupus · doi:10.1177/0961203321990100 · Cited by 16
“Vascular thrombosis can result in cutaneous necrosis and digital gangrene in patients with APS.33 Its prevalence ranges from 3.3% to 7.5%.2 In 1.9% to 2.5% of patients, this is the presenting sign.2 The process starts with erythematous macules, cyanosis, or pseudocellulitis culminating in necrosis.28 Peripheral pulses…”
BackgroundInfluentialUgarte, A., de Bustos, A. G., Ruiz‐Arruza, I., Soto-Peleteiro, A., Martín‐Iglesias, D., González-Echávarri, C., & Ruiz‐Irastorza, G. (2021) · Rheumatology · doi:10.1093/rheumatology/keab307 · Cited by 13
Self-citationAntiphospholipid syndrome–mediated acute cerebrovascular diseases and long-term outcomes
Garcia-Grimshaw, M. A., Posadas-Pinto, D. R., Jiménez‐Ruiz, A., Valdés‐Ferrer, S. I., Cadena‐Fernández, A., Torres-Ruiz, J. J., Barrientos-Guerra, J. D., Amancha, M., Chiquete, E., Flores-Silva, F., et al. (2022) · Lupus · doi:10.1177/09612033221074178 · Cited by 13
Gamea, G. A., Elmehy, D. A., Salama, A. M., Soliman, N. A., Afifi, O. K., Elkaliny, H. H., Gheit, R. E. A. E., El-Ebiary, A., Tahoon, D. M., Elkholy, R. A., et al. (2022) · Acta Tropica · doi:10.1016/j.actatropica.2022.106508 · Cited by 13
Barilaro, G., Coloma, E., Chacur, C. A., Rocca, C. D., Pérez-Isidro, A., Ruiz‐Ortiz, E., Viñas, O., Penella, D. T., Reverter, J. C., Andújar, A. M., et al. (2022) · Autoimmunity Reviews · doi:10.1016/j.autrev.2022.103208 · Cited by 15
Self-citationEvangelatos, G., Konstantonis, G. D., Tentolouris, N., Sfikakis, P. P., & Tektonidou, M. G. (2023) · Rheumatology · doi:10.1093/rheumatology/kead267 · Cited by 13
“The 2022 EULAR recommendations for CVD risk management in patients with RMDs, including SLE and APS [7], as well as the 2019 EULAR recommendations for the management of APS in adults [45], underlined the importance of risk stratification in these patients.”
MethodSelf-citationRenna, S. A., Zhao, X., Kunapuli, S. P., et al. (2023) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/atvbaha.123.319434 · Cited by 13
Skeith, L., Rodger, M. A., Bates, S. M., Gonsalves, C., Karovitch, A. J., & Taylor, T. (2021) · Thrombosis and Haemostasis · doi:10.1055/a-1366-9261 · Cited by 14
Berman, A., Kenet, G., Lubetsky, A., Agmon‐Levin, N., Soffer, S., Barg, A. A., Levy‐Mendelovich, S., Cohen, O., Radinsky, L. W., Lalezari, S., et al. (2025) · RMD Open · doi:10.1136/rmdopen-2025-005825 · Cited by 12
“7 Yet, the effectiveness of HCQ in reducing APS complications during pregnancy is still not well-established.”
Micco, P. D., Camporese, G., Cardillo, G., Lodigiani, C., Carannante, N., Annunziata, A., Fiorentino, G., Russo, V., & Imbalzano, E. (2021) · Medicina · doi:10.3390/medicina57100997 · Cited by 12
“From a clinical point of view, thrombocytopenia in patients with APS is mild and rarely associated with bleeding, while mechanisms that induce thrombocytopenia are still the matter under discussion, although the binding of antiphospholipid antibodies on the platelet surface, inducing platelet activation and thrombus f…”
BackgroundMethodRicard, L., Laurent, C., Papo, M., Deriaz, S., Catano, J., Alamowitch, S., Kayem, G., Chasset, F., MOREUIL, C. D., Boffa, J. J., et al. (2021) · Joint Bone Spine · doi:10.1016/j.jbspin.2021.105297 · Cited by 14
Martínez-Taboada, V. M., Blanco-Olavarri, P., Barrio-Longarela, S. D., Riancho‐Zarrabeitia, L., Merino, A., Comins‐Boo, A., López‐Hoyos, M., & Hernández, J. L. (2022) · Biomedicines · doi:10.3390/biomedicines10112938 · Cited by 12
Stroke and Risk Factors in Antiphospholipid Syndrome
Fan, Y., Xu, Y., Zhang, S., et al. (2023) · Journal of Personalized Medicine · doi:10.3390/jpm14010024 · Cited by 12
Deciphering the clinical significance of longitudinal antiphospholipid antibody titers
Chighizola, C. B., Willis, R., Maioli, G., Sciascia, S., Andréoli, L., Amengual, O., Radin, M., Gerosa, M., Atsumi, T., de Jesús, G. R., et al. (2024) · Autoimmunity Reviews · doi:10.1016/j.autrev.2023.103510 · Cited by 16
Self-citationGajić, M., Schröder‐Heurich, B., & Mayer-Pickel, K. I. (2024) · Frontiers in Pharmacology · doi:10.3389/fphar.2024.1298928 · Cited by 14
Nossent, J. C., Keen, H. I., Preen, D. B., et al. (2024) · Lupus · doi:10.1177/09612033241247359 · Cited by 12
Chen, Y., Xu, W., Huang, S., Li, J., Li, T., Chen, J., Yu, L., & Zhang, J. (2024) · American Journal of Reproductive Immunology · doi:10.1111/aji.13940 · Cited by 12
Schreiber, K. I., Aguilera, S., Amengual, O., Cohen, H., ANDRADE, D. C. O. D., Duarte‐García, A., Gerosa, M., Nelson‐Piercy, C., Radin, M., Raio, L., et al. (2025) · The Lancet Rheumatology · doi:10.1016/s2665-9913(24)00396-5 · Cited by 12
Self-citationCelia, A. I., Vescovo, G. M., Sarto, G., Alessandri, C., Iaconelli, A., D’Amario, D., Frati, G., Conti, F., Sciarretta, S., Angiolillo, D. J., et al. (2025) · Seminars in Arthritis and Rheumatism · doi:10.1016/j.semarthrit.2025.152741 · Cited by 12
Egiziano, G., Widdifield, J., Rahman, A., et al. (2020) · Scientific Reports · doi:10.1038/s41598-020-59990-5 · Cited by 12
The past, present and future of RNA respiratory viruses: influenza and coronaviruses
Makarov, V., Riabova, O., Ekins, S., Pluzhnikov, N., & Chepur, S. (2020) · Pathogens and Disease · doi:10.1093/femspd/ftaa046 · Cited by 13
“1992; Schrezenmeier and Dorner 2020); treatment of antiphospholipid syndrome (Tektonidou et al. 2019); treatment of Sjogren’s syndrome (Vivino et al.”
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Metadata
- Authors
- Tektonidou, M. G., Andreoli, L., Limper, M., Amoura, Z., Cervera, R., Costedoat-Chalumeau, N., Cuadrado, M. J., Dörner, T., Ferrer-Oliveras, R., Hambly, K., Khamashta, M. A., King, J., Marchiori, F., Meroni, P. L., Mosca, M., Pengo, V., Raio, L., Ruiz-Irastorza, G., Shoenfeld, Y., Stojanovich, L., Svenungsson, E., Wahl, D., Tincani, A., & Ward, M. M.
- Affiliations
- National and Kapodistrian University of Athens (GR)
- University Medical Center Utrecht (NL)
- Sorbonne Université (FR)
- Hospital Clínic de Barcelona (ES)
- Inserm (FR)
- Charité – Universitätsmedizin Berlin (DE)
- University of Kent (GB)
- Dubai Hospital (AE)
- European League Against Rheumatism (CH)
- IRCCS Istituto Auxologico Italiano (IT)
- University of Pisa (IT)
- University of Padua (IT)
- University Hospital of Bern (CH)
- Tel Aviv University (IL)
- University of Belgrade (RS)
- Karolinska University Hospital (SE)
- National Institutes of Health (US)
- ORCID
- Tektonidou, Maria G
- Andreoli, Laura
- Amoura, Zahir
- Cervera, Ricard
- Costedoat-Chalumeau, Nathalie
- Dörner, Thomas
- Hambly, Karen
- Khamashta, Munther A
- Marchiori, Francesca
- Meroni, Pier Luigi
- Mosca, Marta
- Pengo, Vittorio
- Raio, Luigi
- Ruiz-Irastorza, Guillermo
- Shoenfeld, Yehuda
- Stojanovich, Ljudmila
- Svenungsson, Elisabet
- Wahl, Denis
- Ward, Michael M
- Venue
- Annals of the Rheumatic Diseases
- Publisher
- Elsevier BV
- Published
- 2019-10
- Volume
- 78
- Issue
- 10
- Pages
- 1296-1304
- ISSN
- 0003-4967 (ISSN-L)
- PMC
- PMC11034817
- OpenAlex
- W2946160313
- Semantic Scholar
- cca4d07183616eebc75996c57f7d029bd63e5bf2
- Cited by
- 1,318
- References
- 72
- Citations by year
- 2026: 200 · 2025: 188 · 2024: 221 · 2023: 191 · 2022: 171 · 2021: 140 · 2020: 163 · 2019: 42
- FWCI
- 87.37
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Annals of the Rheumatic Diseases (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion, cc-by-nc)
- BORIS (University Library Bern) (submittedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion)
- Kent Academic Repository (University of Kent) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- European League Against Rheumatism
- Topics
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Keywords
- antiphospholipid syndrome, antiphospholipid antibodies, thrombosis, obstetric antiphospholipid syndrome, low-dose aspirin, vitamin K antagonists, rivaroxaban, low molecular weight heparin, recurrent thrombosis, pregnancy, systemic lupus erythematosus, hydroxychloroquine, prednisolone, thromboprophylaxis, cardiovascular risk
- MeSH terms
- Adult, Anticoagulants, Female, Humans, Male, Pregnancy, Pregnancy Complications, Rheumatology, Risk Factors, Antiphospholipid Syndrome, Antibodies, Antiphospholipid, Practice Guidelines as Topic, Venous Thrombosis
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-08, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-08 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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