Skip to main content
SpringerLink
Log in

Evidence-based management of thrombosis in the antiphospholipid antibody syndrome

  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

Abstract

Recommendations for the management of thrombosis in the antiphospholipid antibody syndrome have been based largely on retrospective case series. Several clinical trials have been recently published on the management of thrombosis in general. Two clinical trials have specifically addressed thrombosis in antiphospholipid antibody syndrome, and one is underway. These new clinical trials have challenged the previous dogma of a target International Normalized Ratio of 3 to 4 (“high-intensity” warfarin).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Somers E, Magder LS, Petri M: Antiphospholipid antibodies and incidence of venous thrombosis in a cohort of patients with SLE. J Rheumatol 2002, 29:2531–2536. This is the author’s prospective study based on the Hopkins Lupus Cohort. LA-positive patients have a 50% chance of a venous thrombosis over 20 years.

    PubMed  CAS  Google Scholar 

  2. Shah NM, Khamashta MA, Atsumi T, Hughes GRV: Outcome of patients with anticardiolipin antibodies: a 10 year followup of 52 patients. Lupus 1998, 7:3–6.

    Article  PubMed  CAS  Google Scholar 

  3. Ginsburg KS, Liang MH, Newcomer L, et al.: Anticardiolipin antibodies and the risk for ischemic stroke and venous thrombosis. Ann Int Med 1992, 117:997–1002. The Physician’s Health Study did not find benefit of aspirin in preventing venous thrombosis in aPL-positive men.

    PubMed  CAS  Google Scholar 

  4. Vaarala O, Manttari M, Manninen V, et al.: Anti-cardiolipin antibodies and risk of myocardial infarction in a prospective cohort of middle-aged men. Circulation 1995, 91:23–27.

    PubMed  CAS  Google Scholar 

  5. Erkan D, Merrill JT, Yazici Y, et al.: High thrombosis rate after fetal loss in antiphospholipid syndrome: effective prophylaxis with aspirin. Arthritis Rheum 2001, 44:1466–1467. Although a retrospective study, low-dose aspirin was found to reduce later thrombosis in aPL-positive women (who had aPL-induced pregnancy morbidity).

    Article  PubMed  CAS  Google Scholar 

  6. Wallace DJ, Linker-Israeli M, Metzger AL, Stecher VJ:The relevance of antimalarial therapy with regard to thrombosis, hypercholesterolemia and cytokines in SLE. Lupus 1993, 2(suppl):S13-S15.

    PubMed  Google Scholar 

  7. Petri M: Hydroxychloroquine use in the Baltimore Lupus Cohort: effects on lipids, glucose and thrombosis. Lupus 1996, 5:S16-S22.

    Article  PubMed  CAS  Google Scholar 

  8. Edwards MH, Pierangeli S, Liu X, et al.: Hydroxychloroquine reverses thrombogenic properties of antiphospholipid antibodies in mice. Circulation 1997, 96:4380–4384.

    PubMed  CAS  Google Scholar 

  9. Schulman S, Svenungsson E, Granqvist S, et al.: Anticardiolipin antibodies predict early recurrence of thromboembolism and death among patients with venous thromboembolism following anticoagulant therapy. Am J Med 1998, 104:332–338. A prospective study proving the high recurrence rate in aPL-induced thrombosis.

    Article  PubMed  CAS  Google Scholar 

  10. Derksen RHWM, de Groot PG, Kater L, Nieuwenhuis HK:Patients with antiphospholipid antibodies and venous thrombosis should receive long term anticoagulant treatment. Ann Rheum Dis 1993, 52:689–692.

    Article  PubMed  CAS  Google Scholar 

  11. Brunner HI, Chan WS, Ginsberg JS, Feldman BM: Longterm anticoagulation is preferable for patients with antiphospholipid antibody syndrome: results of a decision analysis. J Rheumatol 2002, 29:490–501.

    PubMed  CAS  Google Scholar 

  12. Khamashta MA, Cuadrado MJ, Mujic F, et al.: The management of thrombosis in the antiphospholipid antibody syndrome. N Engl J Med 1995, 332:993–997. The largest retrospective series, which led to the recommendation of high-intensity warfarin to prevent recurrence.

    Article  PubMed  CAS  Google Scholar 

  13. Rosove MH, Brewer PMC: Antiphospholipid thrombosis: clinical course after the first thrombotic event in 70 patients. Ann Intern Med 1992, 117:303–308.

    PubMed  CAS  Google Scholar 

  14. Asherson RA, Espinosa G, Cervera R, et al.: Catastrophic antiphospholipid syndrome: proposed guidelines for diagnosis and treatment. J Clin Rheumatol 2002, 8:157–165.

    Article  PubMed  Google Scholar 

  15. Schulman S, Rhedin AS, Lindmarker P, et al.: A comparison of six weeks with six months of oral anticoagulant therapy after a first episode of venous thromboembolism. Duration of Anticoagulation Trial Study Group. N Engl J Med 1995, 332:1661–1665.

    Article  PubMed  CAS  Google Scholar 

  16. Agnelli G, Prandoni P, Santamaria MG, et al.: Three months versus one year of oral anticoagulant therapy for idiopathic deep venous thrombosis. Warfarin Optimal Duration Italian Trial Investigators. N Engl J Med 2001, 345:165–169.

    Article  PubMed  CAS  Google Scholar 

  17. Kearon C, Gent M, Hirsh J, et al.: A comparison of three months of anticoagulation with extended anticoagulation for a first episode of idiopathic venous thromboembolism. N Engl J Med 1999, 340:901–907.

    Article  PubMed  CAS  Google Scholar 

  18. Schulman S, Granqvist S, Holmstrom M, et al.: The duration of oral anticoagulant therapy after a second episode of venous thromboembolism. The Duration of Anticoagulation Trial Study Group. N Engl J Med 1997, 336:393–398.

    Article  PubMed  CAS  Google Scholar 

  19. Leon MB, Baim DS, Popma JJ, et al.: A clinical trial comparing three antithrombotic-drug regimens after coronary-artery stenting. Stent Anticoagulation Restenosis Study Investigators. N Engl J Med 1998, 339:1665–1671.

    Article  PubMed  CAS  Google Scholar 

  20. Mohr JP, Thompson JL, Lazar RM, et al.: A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke. N Engl J Med 2001, 345:1444–1451.

    Article  PubMed  CAS  Google Scholar 

  21. Hurlen M, Abdelnoor M, Smith P, et al.: Warfarin, aspirin, or both after myocardial infarction. N Engl J Med 2002, 347:969–974.

    Article  PubMed  CAS  Google Scholar 

  22. Ridker PM, Goldhaber SZ, Danielson E, et al.: Long-term, low-intensity warfarin therapy for the prevention of recurrent venous thromboembolism. N Engl J Med 2003, 348:1425–1434.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine: Rheumatology, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 7500, 21205, Baltimore, MD, USA

    Michelle Petri MD, MPH

Authors
  1. Michelle Petri MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Petri, M. Evidence-based management of thrombosis in the antiphospholipid antibody syndrome. Curr Rheumatol Rep 5, 370–373 (2003). https://doi.org/10.1007/s11926-003-0023-7

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11926-003-0023-7

Keywords

Search

Navigation