06/07/2002
By Anne MacLennan
Risk of thrombotic recurrences is high in patients with definite antiphospholipid syndrome and previous thrombosis, even during anticoagulation.
Moreover, recurrences usually take place in the same territory as did the original event, suggests an analysis of 66 such patients treated with oral anticoagulation to a target international normalised ratio of 3.5.
As for intracranial and fatal bleeding in these patients, risk was found to be similar to that in patients treated to lower target ratios in this study from the Lupus Research Unit, St Thomas’ Hospital, London, England and the Service of Internal Medicine, Hospital de Cruces, Bizkaia, Spain.
Although the treatment of choice for patients with both this syndrome and thrombosis is prolonged anticoagulation, debate continues about what is the optimum intensity for the anticoagulation.
The 66 patients in this study were mainly women and white, all had antiphospholipid syndrome (Sapporo criteria) and previous thrombosis and all were receiving oral anticoagulation to a target international normalized ratio of 3.5. Guillermo Ruiz-Irastorza and colleagues interviewed the subjects on their recall of major bleeding and thrombotic episodes in the previous 12 months.
Rate of major bleeding was six cases per 100 patient-years, and rate of intracranial bleed was 1.5 per 100 patient-years. None of the bleeding episodes was fatal.
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