PMID: 11908562Mar 23, 2002Paper

Longterm anticoagulation is preferable for patients with antiphospholipid antibody syndrome. result of a decision analysis

The Journal of Rheumatology
Hermine I BrunnerBrian M Feldman

Abstract

Patients with antiphospholipid antibody syndrome (APS) have a high risk for rethrombosis. Anticoagulation with warfarin and aspirin reduces the frequency of recurrences. No universally accepted approach regarding the duration and intensity of antithrombotic therapy exists. We investigated the best antithrombotic regimen for patients with APS after the first deep venous thrombosis (DVT). We identified 6 anticoagulation regimens used in such patients, the rates of morbidity and mortality associated with bleeding, and the rates of recurrent thrombosis associated with APS by literature search. A decision tree was developed and the expected risks and benefits of each anticoagulation regimen were assessed at 2 different time points: at one year and again 4 years after the initial thrombosis. Based on the decision analysis, longterm warfarin alone at an international normalization ratio (INR) between 3.0 and 4.0 had the highest expected utility of the 6 antithrombotic regimens, both one year and 4 years after the initial venous thrombotic event. Short term anticoagulation for only 6 months is less beneficial. Combination therapy of warfarin and aspirin (ASA) does not offer an improvement in the expected utility over warfarin alone. Al...Continue Reading

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Antiphospholipid Syndrome

Antiphospholipid syndrome or antiphospholipid antibody syndrome (APS or APLS), is an autoimmune, hypercoagulable state caused by the presence of antibodies directed against phospholipids.