Arthritis und Rheuma 2019; 39(01): 37-43
DOI: 10.1055/a-0828-6613
Schwerpunkt
© Georg Thieme Verlag KG Stuttgart · New York

Das Antiphospholipidsyndrom

Anti-Phospholipid Syndrome
Thomas Rose
1   Charité - Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie
,
Thomas Dörner
1   Charité - Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie
› Author Affiliations
Further Information

Publication History

Publication Date:
13 March 2019 (online)

Zusammenfassung

Das Antiphospholipidsyndrom (APS) ist eine seltene Erkrankung, die klinisch mit thrombembolischen Ereignissen einhergeht und häufig verbunden ist mit Schwangerschaftskomplikationen. Die Antiphospholipid-Antikörper sind ein zentraler Bestandteil in der Pathogenese des APS und haben über den prokoagulatorischen Effekt hinaus Auswirkungen auf das Immunsystem. Der Nachweis der Antiphospholipid-Antikörper gilt bei Gesunden als Risiko für thrombembolische Ereignisse und die sogenannte Tripel-Positivität ist dabei mit einem besonders hohen Risiko für thrombembolische Ereignisse verbunden. Die Therapie des APS ist abhängig von der klinischen Konstellation und umfasst die Gabe von ASS und Vitamin-K-Antagonisten bzw. Heparin. Die direkten orale Antikoagulanzien sind zwar häufig im Label anwendbar, allerdings zeigt eine aktuelle Studie eine höhere Rezidivrate bei tripel-positiven APS-Patienten unter Rivaroxaban.

Abstract

The antiphospholipid syndrome is a rather infrequent but severe acquired thrombembolic disease leading to arterial or venous occlusions or pregnancy complications. Autoantibodies against phospholipid structures are key in the pathogenesis having a procoagulatory potency including immune effects, such as complement activation. The most pronounced risk is associated with the presence of anticardiolipin and ß2-glycoprotein I antibodies and positive lupus anticoagulant (triple positivity). The therapeutic mainstay of APS depends on the underlying condition, but is usually based on ASS and/or vitamin K antagonists, as well as heparin at prophylactic or therapeutic dosages. Notably, direct oral anticoagulants, in particular rivaroxaban should not be used in triple-positive APS for secondary prophylaxis.

 
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