Recommendations of the Spanish Rheumatology Society for primary antiphospholipid syndrome. Part I: Diagnosis, evaluation and treatment

• Published in: Reumatología clinica (Barcelona) 2020-03, Vol.16 (2), p.71-86
• Main Authors: Cáliz Cáliz, Rafael, Díaz del Campo Fontecha, Petra, Galindo Izquierdo, María, López Longo, Francisco Javier, Martínez Zamora, María Ángeles, Santamaría Ortiz, Amparo, Amengual Pliego, Olga, Cuadrado Lozano, María José, Delgado Beltrán, María Paloma, Carmona Ortells, Loreto, Cervantes Pérez, Evelin Cecilia, Díaz-Cordovés Rego, Gisela, Garrote Corral, Sandra, Fuego Varela, Clara, Martín López, María, Nishishinya, Betina, Novella Navarro, Marta, Pereda Testa, Claudia, Sánchez Pérez, Hiurma, Silva-Fernández, Lucia, Martínez Taboada, Víctor Manuel
• Format: Article
• Language: English
• Subjects: Anticuerpos antifosfolípidos; Antiphospholipid antibodies; Antiphospholipid syndrome; Diagnosis; Diagnóstico; Obstetric APS; Recomendaciones; Recommendations; SAF obstétrico; Sociedad Española de Reumatología; Spanish Society of Rheumatology; Síndrome antifosfolípido; Tratamiento; Treatment
• ISSN: 2173-5743; 2173-5743
• DOI: 10.1016/j.reumae.2018.11.012

The difficulty in diagnosis and the spectrum of clinical manifestations that can determine the choice of treatment for primary antiphospholipid syndrome (APS) has fostered the development of recommendations by the Spanish Society of Rheumatology (SER), based on the best possible evidence. These recommendations can serve as a reference for rheumatologists and other specialists involved in the management of APS. A panel of four rheumatologists, a gynaecologist and a haematologist with expertise in APS was created, previously selected by the SER through an open call or based on professional merits. The stages of the work were: identification of the key areas for drafting the document, analysis and synthesis of the scientific evidence (using the Scottish Intercollegiate Guidelines Network [SIGN] levels of evidence) and formulation of recommendations based on this evidence and formal assessment or reasoned judgement techniques (consensus techniques). 46 recommendations were drawn up, addressing five main areas: diagnosis and evaluation, measurement of primary thromboprophylaxis, treatment for APS or secondary thromboprophylaxis, treatment for obstetric APS and special situations. These recommendations also include the role of novel oral anticoagulants, the problem of recurrences or the key risk factors identified in these subjects. This document reflects the first 21, referring to the areas of: diagnosis, evaluation and treatment of primary APS. The document provides a table of recommendations and treatment algorithms. An update of the SER recommendations on APS is presented. This document corresponds to part I, related to diagnosis, evaluation and treatment. These recommendations are considered tools for decision-making for clinicians, taking into consideration both the decision of the physician experienced in APS and the patient. A part II has also been prepared, which addresses aspects related to obstetric SAF and special situations. La dificultad para el diagnóstico y la variedad de manifestaciones clínicas que pueden determinar la elección del tratamiento del síndrome antifosfolípido (SAF) primario ha impulsado a la Sociedad Española de Reumatología (SER) en la elaboración de recomendaciones basadas en la mejor evidencia posible. Estas recomendaciones pueden servir de referencia para reumatólogos y otros profesionales implicados en el manejo de pacientes con SAF. Se creó un panel formado por cuatro reumatólogos, una ginecóloga y una hematóloga, expertos en