Artículo especialRecomendaciones de la Sociedad Española de Reumatología sobre síndrome antifosfolípido primario. Parte II: síndrome antifosfolípido obstétrico y situaciones especialesRecommendations of the Spanish Rheumatology Society for Primary Antiphospholipid Syndrome. Part II: Obstetric Antiphospholipid Syndrome and Special Situations
Section snippets
Resultados
El total de recomendaciones formuladas sobre síndrome antifosfolípido (SAF) primario es de 46, que abordan 5 áreas principales: diagnóstico y evaluación, tromboprofilaxis primaria, tratamiento del SAF primario o tromboprofilaxis secundaria, tratamiento del SAF obstétrico y situaciones especiales. En este documento se reflejan las últimas 25, referidas a las áreas de: SAF obstétrico y situaciones especiales (tabla 1).
Embarazo y síndrome antifosfolípido primario
En una paciente con SAF obstétrico, ¿qué tratamientos se muestran más eficaces?
Recomendación: Se sugiere el uso preconcepcional de ácido acetilsalicílico a dosis de 100 mg/día en todas las pacientes con SAF obstétrico que quieran quedarse embarazadas y su mantenimiento durante todo el embarazo (Recomendación de grado C).
Recomendación: En las pacientes con SAF obstétrico se recomienda como tratamiento profiláctico secundario añadir al ácido acetilsalicílico la heparina de bajo peso molecular
Trasplante de órgano sólido
En pacientes con síndrome antifosfolípido que precisen un trasplante de órgano sólido, ¿cuál debe ser la actitud terapéutica?
Recomendación: Se recomienda un control riguroso de la anticoagulación antes y después de un trasplante de órgano sólido, especialmente en caso de trasplante renal (Recomendación de grado √).
Recomendación: Se recomienda el despistaje rutinario de anticuerpos antifosfolípidos antes del trasplante de órgano sólido en todos los pacientes con antecedentes de eventos
Conclusiones
Se presenta el primer consenso oficial de la SER sobre el diagnóstico y tratamiento del SAF primario. Tras una exhaustiva revisión de la evidencia científica y al no existir muchos estudios de alta calidad, las recomendaciones se han basado fundamentalmente en revisiones sistemáticas, estudios de cohortes y de casos y controles, y en la opinión de expertos.
Se han elaborado 25 recomendaciones para las áreas de tratamiento del SAF obstétrico y situaciones especiales, como el SAF catastrófico. A
Financiación
Fundación Española de Reumatología.
Conflicto de intereses
Rafael Cáliz Cáliz ha recibido financiación de Abbvie, Pfizer, Roche, Novartis, MSD, UCB y GSK para la asistencia a cursos/congresos y ha recibido honorarios de la SER en concepto de ponencias y redacción de capítulos de libros.
Víctor Manuel Martínez Taboada ha recibido financiación de Abbvie, Menarini y Pfizer para la asistencia a cursos/congresos; honorarios de Abbvie, MSD, Novartis, BMS y Roche en concepto de ponencias; financiación de Servier por participar en una investigación; ayuda
Agradecimientos
El grupo de expertos del presente trabajo quiere manifestar su agradecimiento a Mercedes Guerra Rodríguez, documentalista de la SER, por su colaboración en las estrategias de búsqueda de la evidencia y al Dr. Sixto Zegarra Mondragón por su colaboración en las revisiones de los informes de revisiones sistemáticas. También quieren agradecer al Dr. Federico Díaz González, director de la Unidad de Investigación de la SER, por su participación en la revisión del manuscrito final y por contribuir a
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