TY - JOUR
T1 - Survey on antiphospholipid syndrome diagnosis and antithrombotic treatment in patients with ischemic stroke, other brain ischemic injury, or arterial thromboembolism in other sites
T2 - communication from ISTH SSC Subcommittee on Lupus Anticoagulant/Antiphospholipid Antibodies
AU - ISTH SSC Lupus Anticoagulant/Antiphospholipid Antibodies Subcommittee Study Group
AU - Cohen, Hannah
AU - Werring, David J.
AU - Chandratheva, Arvind
AU - Mittal, Prabal
AU - Devreese, Katrien M.J.
AU - Isenberg, David A.
AU - Amoura, Zahir
AU - Andrade, Danieli
AU - Baccouche, Hela
AU - Baldwin, Neil
AU - Baysal, Mehmet
AU - Belmont, H. Michael
AU - Bertolaccini, M. Laura
AU - Billett, Henny
AU - Cervera, Ricard
AU - Cotelli, Maria Sofia
AU - Crowther, Mark
AU - Devreese, Katrien
AU - Dounaevskaia, Vera
AU - Doyle, Andrew J.
AU - Barros Duran, Leandro Francisco
AU - Engelbrecht, Sunelle
AU - Efthymiou, Maria
AU - Erkan, Doruk
AU - Gatt, Alex
AU - Gebhart, Johanna
AU - Harkness, Kirsty
AU - Hemelsoet, Dimitri
AU - Hoirisch-Clapauch, Silvia
AU - Inanc, Murat
AU - Isenberg, David
AU - Iturre, Maximiliano Villagra
AU - Kalladka, Dheeraj
AU - Kamphuisen, Pieter W.
AU - Kartsios, Charalampos
AU - Khamashta, Munther
AU - Kouides, Peter A.
AU - Levine, Steven R.
AU - Limper, Maarten
AU - Luchtman-Jones, Lori
AU - Maclean, Rhona
AU - Mitchell, Christopher
AU - Moll, Rachel
AU - Molnar, Soledad
AU - Moyer, Genevieve Claire
AU - Muñoz Muñoz, Cándido
AU - Murphy, Sean
AU - Nwagha, Theresa
AU - Orsi, Fernanda A.
AU - Pardos-Gea, José
N1 - Publisher Copyright:
© 2023 International Society on Thrombosis and Haemostasis
PY - 2023/10
Y1 - 2023/10
N2 - Background: The optimal strategy for diagnosis and antithrombotic treatment of patients with antiphospholipid syndrome (APS)–associated acute ischemic stroke (AIS), transient ischemic attack (TIA), or other brain ischemic injury is poorly defined. Objectives: The survey goal was to capture variations in diagnosis and antithrombotic treatment of APS-associated ischemic stroke and related disorders to inform guidance and clinical trials to define optimal management. Methods: Professional colleagues, including key opinion leaders, were invited to complete a REDCap survey questionnaire initiated by the International Society on Thrombosis and Haemostasis Scientific and Standardisation Committee Subcommittee on Lupus Anticoagulant/Antiphospholipid Antibodies. The survey data were tallied using simple descriptive statistics. Results: There was generally good agreement on several aspects, including which patients to test for antiphospholipid antibodies (aPL), use of a lifelong vitamin K antagonist for AIS or recurrent TIA, and formal cognitive assessment for suspected cognitive impairment. There was less agreement on other aspects, including aPL testing for brain ischemic injury other than AIS/TIA or if an alternative cause for AIS or TIA exists; choice of aPL tests, their timing, and age cutoff; the aPL phenotype to trigger antithrombotic treatment; management for patent foramen ovale; antithrombotic treatment for first TIA or white matter hyperintensities; head magnetic resonance imaging specifications; and low-molecular-weight heparin dosing/anti-Xa monitoring in pregnancy. The survey highlighted that approximately 25% practice at dedicated APS clinics and <50% have a multidisciplinary team structure for patients with APS. Conclusion: Much of the variation in practice reflects the lack of evidence-based recommendations. The survey results should inform the development of a more uniform multidisciplinary consensus approach to diagnosis and antithrombotic treatment.
AB - Background: The optimal strategy for diagnosis and antithrombotic treatment of patients with antiphospholipid syndrome (APS)–associated acute ischemic stroke (AIS), transient ischemic attack (TIA), or other brain ischemic injury is poorly defined. Objectives: The survey goal was to capture variations in diagnosis and antithrombotic treatment of APS-associated ischemic stroke and related disorders to inform guidance and clinical trials to define optimal management. Methods: Professional colleagues, including key opinion leaders, were invited to complete a REDCap survey questionnaire initiated by the International Society on Thrombosis and Haemostasis Scientific and Standardisation Committee Subcommittee on Lupus Anticoagulant/Antiphospholipid Antibodies. The survey data were tallied using simple descriptive statistics. Results: There was generally good agreement on several aspects, including which patients to test for antiphospholipid antibodies (aPL), use of a lifelong vitamin K antagonist for AIS or recurrent TIA, and formal cognitive assessment for suspected cognitive impairment. There was less agreement on other aspects, including aPL testing for brain ischemic injury other than AIS/TIA or if an alternative cause for AIS or TIA exists; choice of aPL tests, their timing, and age cutoff; the aPL phenotype to trigger antithrombotic treatment; management for patent foramen ovale; antithrombotic treatment for first TIA or white matter hyperintensities; head magnetic resonance imaging specifications; and low-molecular-weight heparin dosing/anti-Xa monitoring in pregnancy. The survey highlighted that approximately 25% practice at dedicated APS clinics and <50% have a multidisciplinary team structure for patients with APS. Conclusion: Much of the variation in practice reflects the lack of evidence-based recommendations. The survey results should inform the development of a more uniform multidisciplinary consensus approach to diagnosis and antithrombotic treatment.
KW - antiphospholipid syndrome
KW - cerebral infarcts
KW - ischemic stroke
KW - survey
KW - transient ischemic attack
KW - white matter hyperintensities
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U2 - 10.1016/j.jtha.2023.06.020
DO - 10.1016/j.jtha.2023.06.020
M3 - Article
C2 - 37391096
AN - SCOPUS:85171671047
SN - 1538-7933
VL - 21
SP - 2963
EP - 2976
JO - Journal of Thrombosis and Haemostasis
JF - Journal of Thrombosis and Haemostasis
IS - 10
ER -