High risk for recurrent TE in APS patients
MedWire News: Patients with antiphospholipid syndrome (APS) who are triple positive for antiphospholipid antibodies (aPL) have a high risk for recurrent thromboembolism (TE), Italian researchers have found.
“These recurrences not only influence morbidity but are also the most common cause of death in APS,” report Vittorio Pengo (University Hospital, Padova) and co-workers in the Journal of Thrombosis and Haemostasis.
“Oral anticoagulant therapy significantly reduces recurrent TE, although it might prove insufficient in some cases.”
The researchers examined data for 160 APS patients attending Italian thrombosis centers who were positive for the aPLs lupus anticoagulant, anti-cardiolipin and anti-β2-glycoprotein I.
The patients had been diagnosed with APS following episodes of venous (V)TE (47.5%), arterial (A)TE (43.1%), pregnancy morbidity (9.7%), and catastrophic APS (2.5%).
Patients were followed-up for an average of 6.0 years, with 89.1% completing 1 year, 46.5% 5 years, and 14.4% 10 years.
Recurrent TE events had occurred in 12.2% of patients after 1 year, 26.1% after 5 years, and 44.2% of patients after 10 years.
Recurrence was a significant 2.4 times more common in patients who did not use oral anticoagulant therapy than in those who did, and oral anticoagulant therapy was the only significant risk factor associated with risk for recurrent TE in multivariate analysis.
Patients treated with oral anticoagulants had a low risk for major bleeding episodes, at a rate of 0.8% per year. Overall, 10 patients died during follow-up, seven of whom from cardiovascular-related deaths caused by cerebral bleeds (one not using anticoagulation) or sudden cardiac death.
“In this cohort, patients treated with oral anticoagulants had significantly less VTE and ATE events,” Pengo et al conclude.
“This finding encourages the use of long-term oral anticoagulant treatment not only in patients with VTE but also in patients with ATE at a stable international normalized ratio between 2.0 and 3.0.
“This range can be increased to 3.0–4.5 after a recurrence during oral anticoagulant therapy, although the benefit of this approach has been questioned by some trials,” they add.
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By Lynda Williams