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Management of the antiphospholipid syndrome. Main trends, unsolved questions, practical and educational aspects.

Therapeutic guidelines are progressively emerging in the antiphospholipid syndrome (APS). For primary APS, prevention of recurrent miscarriages is frequently achieved by a combination of heparin plus aspirin. Steroids should not be used in the absence of associated systemic lupus erythematosus. Long term warfarin aimed at an INR of 3-3.5 is effective for the secondary prevention of thrombosis. However, some doubt is raising regarding the pertinence of INR monitoring in patients with a lupus anticoagulant. Education is an important part of the management of patients with APS. Coincident risk factors for thrombosis have to be suppressed or controlled. Psychological aspects also need to be carely considered during the course of this chronic disorder.