Aspirin and antiphospholipid syndrome.

Introduction - Antiphospholipid syndrome is the most frequent cause of acqu ired thrombophilia. Aspirin may have some indications. Current konwledge and key points - The usefulness of low doses of aspirin i s now well demonstrated in the prevention of obstetric complications associ ated with antiphospholipid antibodies (especially pregnancy loss). When hep arin is combined with low-dose aspirin, the recurrent rate of fetal loss is lower than 30%. In patients with arterial or venous thrombosis, there is a high rate of recurrence during the two first years except if high-dose war farin was used (i.e., INR greater than or equal to 3). The association warf arin-aspirin in secondary prevention of thrombosis may be evaluated in pros pective studies. It is not so clear in the literature and in our experience that warfarin is superior to aspirin in stroke recurrence prevention in pa tients with antiphospholipid antibodies, except in Sneddon's syndrome. Ther e are no guidelines in primary thrombosis prevention in patients with antip hospholipid antibodies. In lupus patients, aspirin may not be sufficient af ter many years of follow-up in preventing a first episode of thrombosis. Pr ospective studies may be undertaken. Atherosclerotic patients with antiphos pholipid antibodies are particularly exposed to the risk of thrombosis afte r revascularisation or angioplasty and stent implantation, Aspirin may have a place in those patients but these must be evaluated. Futur prospects and projects - Except in prevention of obstetric complicati ons, the usefulness of aspirin in patients with antiphospholipid antibodies must be evaluated in prospective studies. (C) 2000 Editions scientifiques et medicales Elsevier SAS.