Other Aspects of the Management of the Antiphospholipid Syndrome
The management of the antiphospholipid syndrome (APS) may have two distinct goals, i.e., to eliminate the antiphospholipid antibodies (aPL) and to prevent their deleterious effects. Education is an important part of the management of patients with APS. Associated risk factors for atherosclerosis require identification and appropriate management, especially in patients presenting with arterial manifestations and/or receiving steroids for systemic lupus erythematosus (SLE). Thrombocytopenia frequently occurs in APS, but usually remains mild and asymptomatic. Heart valve abnormalities have been reported to be associated with aPL in SLE and to occur frequently in primary APS. Replacement therapy of aPL-related adrenal failure has no specificity and consists of both gluco- and mineralocorticoids. The catastrophic APS and/or widespread cutaneous necrosis clearly fails to respond to heparin, even when associated with steroids. Little is known about primary prevention, which probably requires distinct approaches depending on the presence, or lack, of SLE.