Antiphospholipid syndrome (APS) is a systemic autoimmune disease characterized by venous,
arterial or microvascular thrombosis or obstetric events in the presence of persistently positive
antiphospholipid antibodies and constitutes a major cause of cardiovascular events in young people.
Τhis review highlights the pathophysiology of cardiovascular complications in patients with APS and
possible treatment options.
Patients with APS have endothelial dysfunction, accelerated endothelial proliferation and intimal hyperplasia,
atherogenesis, platelet activation, inflammatory products secretion and coagulation-fibrinolytic
dysregulation. Cardiovascular complications include accelerated atherosclerosis, acute coronary syndrome,
Libman-Sacks endocarditis, cardiomyopathy and venous, arterial or intracardiac thrombi.
Moreover, pulmonary hypertension and peripheral microvascular dysfunction are common findings.
Management of these patients is not well documented. The role of primary thrombosis prevention remains
controversial in individuals with positive antiphospholipid antibodies. Treatment of traditional
cardiovascular risk factors according to current guidelines for the prevention of cardiovascular disease
in the general population is recommended for primary prevention of APS. Anticoagulation therapy with
unfractionated or low-molecular-weight heparin overlapped with a vitamin K antagonist remains the
mainstay of the treatment for APS patients with venous thrombosis, whereas direct oral anticoagulants
are not yet recommended. Data are scarce regarding the secondary arterial thrombosis prevention and it
is not clear whether dual or triple antithrombotic therapy is necessary. To date, it is recommended to
follow current guidelines for the management of acute coronary syndrome in the general population.
New treatment targets are promising options for patients with catastrophic APS.