[Antiphospholipid syndrome. A better codified treatment].

Therapeutic guidelines are progressively emerging for the antiphospholipid syndrome (APS). In the absence of associated systemic lupus erythematosus, i.e. in primary APS, the prevention of recurrent miscarriages is frequently achieved by a combination of heparin plus aspirin. To date, there is no agreement about the type and the dose of heparin to use. Steroids should not be proposed for the prevention of miscarriages in primary APS. Long term warfarin aimed at an International Normalized Ratio (INR) of 3-3.5 is effective for secondary prevention of thrombosis. However, the appropriateness of INR for warfarin monitoring has been recently questioned in the presence of a lupus anticoagulant. Education plays an important role in the management of patients with APS. Particularly, coincident risk factors for thrombosis have to be suppressed or controlled.