PREPORUKE EVROPSKE LIGE PROTIV REUMATIZMA (EULAR) ZA PROFILAKSU I LEČENJE ANTIFOSFOLIPIDNOG SINDROMA KOD ODRASLIH
Sažetak
Antifosfolipidni sindrom (AFS) retka je bolest koju karakterišu venske i/ili arterijske tromboze, komplikacije u trudnoći i prisustvo specifičnih autoantitela, koja se zovu antifosfolipidna antitela. Evropska liga za reumatizam (EULAR) objavila je preporuke za prevenciju i lečenje AFS kod odraslih na osnovu pregleda medicinske literature i mišljenja eksperata iz ove oblasti. Niske doze aspirina se preporučuju kod asimptomatskih nosioca antifosfolipidnih antitela, pacijenata sa sistemskim eritemskim lupusom, bez tromboza ili akušerskih komplikacija, žena sa istorijom akušerskog AFS, pod uslovom da su nosioci visokorizičnog profila antifosfolipidnih antitela. Pacijenti sa AFS i venskom trombozom treba da primene dugoročni tretman sa antagonistima vitamina K i ciljnim vrednostima INR 2–3. Kod pacijenata sa AFS i arterijskom trombozom preporučuje se tretman sa antagonistima vitamina K i ciljnim vrednostima INR 3–4 ili 2–3 prema proceni rizika od krvavljenja/tromboza. Pacijentima s rekurentnim trombozama uprkos terapiji treba dodati niske doze aspirina ili povećati ciljnu vrednost INR na 3–4 ili uvesti niskomolekularni heparin. Kod žena sa akušerskim AFS u toku trudnoće preporučuje se profilaksa niskim dozama aspirina i heparina. Kod ponavljanih komplikacija u trudnoći dozu heparina treba povećati do terapijske doze, dodati hidroksihlorokvin ili male doze prednizolona u prvom trimestru trudnoće. Ove preporuke treba do pomognu kao terapijski vodič za prevenciju i lečenje AFS.
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