Abstract：
In this review, we discuss the current evidence on classic and newer oral anticoagulant therapy, older drugs such as HCQ and statins, and new potential treatment targets in APS. Vitamin K antagonists (VKAs) remain the cornerstone treatment for thrombotic events in APS. In patients fulfilling criteria for definite APS presenting with a first venous thrombosis, treatment with VKAs with a target international normalized ratio (INR) 2.0-3.0 is recommended. In patients with arterial thrombosis, treatment with VKA with target INR 2.0-3.0 or 3.0-4.0 is recommended by recent guidelines, considering the individual\'s bleeding and thrombosis recurrence risk. A combination of VKAs and low-dose aspirin (75-100 mg/daily) may also be considered. According to available evidence direct oral anticoagulants should be avoided in patients with arterial thrombosis and/or those with triple aPL positivity. Adjunctive treatment with HCQ and/or statins can be considered, especially in anticoagulation treatment-refractory APS. Potential targeted treatments in APS include B-cell targeting, complement inhibition, mammalian target of rapamycin inhibition, IFN targeting, adenosine receptors agonists, CD38 targeting or chimeric antigen receptor T-cell therapy. The safety and efficacy of these treatment targets needs to be examined in well-designed randomized controlled trials.
摘要：
在这次审查中,我们讨论经典和较新的口服抗凝治疗的现有证据，老药如HCQ和他汀类药物，和APS新的潜在治疗目标。维生素K拮抗剂（VKAs）仍然是APS血栓形成事件的基础治疗。在符合出现首次静脉血栓的明确APS标准的患者中，建议使用目标国际标准化比率（INR）2.0-3.0的VKAs治疗。在动脉血栓形成的患者中，最近的指南建议用VKA治疗，目标INR2.0-3.0或3.0-4.0，考虑个体的出血和血栓复发风险。还可以考虑VKAs和低剂量阿司匹林(75-100mg/天)的组合。根据现有证据，动脉血栓形成和/或三重aPL阳性的患者应避免直接口服抗凝剂。可以考虑使用HCQ和/或他汀类药物进行辅助治疗，尤其是抗凝治疗难治性APS。APS的潜在靶向治疗包括B细胞靶向，补体抑制,哺乳动物雷帕霉素抑制靶，IFN靶向，腺苷受体激动剂，CD38靶向或嵌合抗原受体T细胞疗法。这些治疗目标的安全性和有效性需要在精心设计的随机对照试验中进行检查。
