The Committee reviewed cardiac involvement in the
antiphospholipid antibody syndrome. The Committee's recommendations are: Valve abnormalities: anticoagulation is recommended for symptomatic patients with valvulopathy. Prophylactic antiplatelet
therapy may be appropriate for asymptomatic patients (recommended by 13/17 experts in an independent review). Committee members disagreed whether
corticosteroid therapy is helpful, but agree that distinguishing among presumptive valvulitis (valve thickening on echocardiogram), valve
deformity and vegetations is important, as treatment implications may differ. Occlusive arterial disease (angina,
myocardial infarction): the Committee recommends aggressive treatment of all risk factors for
atherosclerosis (
hypertension, hypercholesterolaemia, smoking) and liberal use of
folic acid,
B vitamins and
cholesterol-lowering drugs (preferably
statins).
Hydroxychloroquine for cardiac protection in APS patients may be considered. The Committee also recommends
warfarin anticoagulation for those who have suffered
thrombosis in the absence of
atherosclerosis, but recognizes that developing data may support the use of
antiplatelet agents instead. Intracardiac thrombi: the Committee recommends intensive
warfarin anticoagulation, and consultation with cardiac surgeons when appropriate.
Ventricular dysfunction: the Committee has no recommendations on this aspect of
cardiac disease.
Pulmonary hypertension: the Committee recommends intensive anticoagulation with
warfarin and clinical trials of
bosentan,
epoprostenol and other new agents.